Healthcare Provider Details

I. General information

NPI: 1568237337
Provider Name (Legal Business Name): RISING TIDE ACUPUNCTURE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2023
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 W JERICHO TPKE
HUNTINGTON NY
11743-6362
US

IV. Provider business mailing address

607 W JERICHO TPKE
HUNTINGTON NY
11743-6362
US

V. Phone/Fax

Practice location:
  • Phone: 631-416-4940
  • Fax: 631-479-3337
Mailing address:
  • Phone: 631-416-4940
  • Fax: 631-479-3337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: GREGORY MCCUE
Title or Position: OWNER
Credential: MD
Phone: 631-416-4940