Healthcare Provider Details

I. General information

NPI: 1851222483
Provider Name (Legal Business Name): ACUSHACK ACUPUNCTURE WELLNESS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 RADIO AVE
MILLER PLACE NY
11764-3125
US

IV. Provider business mailing address

220 INDIAN HEAD RD
KINGS PARK NY
11754-4802
US

V. Phone/Fax

Practice location:
  • Phone: 631-849-1730
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: JASON MOSS
Title or Position: CO-OWNER
Credential: MS, LAC
Phone: 631-912-7035