Healthcare Provider Details

I. General information

NPI: 1508742966
Provider Name (Legal Business Name): SERENITY ACUPUNCTURE & MASSAGE THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2025
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 HAMILTON PL
LAKE GROVE NY
11755-1916
US

IV. Provider business mailing address

323 E MAIN ST STE 3
SMITHTOWN NY
11787-2822
US

V. Phone/Fax

Practice location:
  • Phone: 631-780-5511
  • Fax:
Mailing address:
  • Phone: 631-780-5511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: XINPING CAO
Title or Position: PRESIDENT
Credential: DAOM
Phone: 631-780-5511