Healthcare Provider Details

I. General information

NPI: 1407651805
Provider Name (Legal Business Name): REISHI ACUPUNCTURE AND MASSAGE THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2025
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 BROADHOLLOW RD STE B12
MELVILLE NY
11747-3701
US

IV. Provider business mailing address

535 BROADHOLLOW RD STE B12
MELVILLE NY
11747-3701
US

V. Phone/Fax

Practice location:
  • Phone: 516-779-1054
  • Fax:
Mailing address:
  • Phone: 516-779-1054
  • 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: JESSIE CHEN
Title or Position: L.AC
Credential:
Phone: 516-779-1054