Healthcare Provider Details

I. General information

NPI: 1528951084
Provider Name (Legal Business Name): ENSO ACUPUNCTURE AND MASSAGE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MELVILLE PARK RD STE 200B
MELVILLE NY
11747-3156
US

IV. Provider business mailing address

25 MELVILLE PARK RD STE 200B
MELVILLE NY
11747-3156
US

V. Phone/Fax

Practice location:
  • Phone: 631-888-5957
  • Fax:
Mailing address:
  • Phone: 631-888-5957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PETER AREBALO
Title or Position: OWNER
Credential: LMT
Phone: 631-834-0246