Healthcare Provider Details

I. General information

NPI: 1144838582
Provider Name (Legal Business Name): PHASES ACUPUNCTURE P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 ROUTE 25A STE A3
MOUNT SINAI NY
11766-2050
US

IV. Provider business mailing address

701 ROUTE 25A STE A3
MOUNT SINAI NY
11766-2050
US

V. Phone/Fax

Practice location:
  • Phone: 631-828-4471
  • Fax:
Mailing address:
  • Phone: 631-828-4471
  • Fax: 631-828-4472

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: SCOTT RE
Title or Position: OWNER/PRESIDENT
Credential: L.AC
Phone: 631-828-4471