Healthcare Provider Details

I. General information

NPI: 1427545763
Provider Name (Legal Business Name): INTRINSIC ENERGY ACUPUNCTURE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2018
Last Update Date: 04/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 N BROADWAY
MASSAPEQUA NY
11758-2394
US

IV. Provider business mailing address

100 BANKS AVE APT 1328
ROCKVILLE CENTRE NY
11570-6212
US

V. Phone/Fax

Practice location:
  • Phone: 516-778-7228
  • Fax:
Mailing address:
  • Phone: 212-671-0993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number005125
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. PETER WU
Title or Position: CEO
Credential: L.AC
Phone: 212-671-0993