Healthcare Provider Details

I. General information

NPI: 1275077703
Provider Name (Legal Business Name): STRAM ACUPUNCTURE AND PHYSICAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2016
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 W 39TH ST SUITE 708
NEW YORK NY
10018-3803
US

IV. Provider business mailing address

55 W 39TH ST SUITE 708
NEW YORK NY
10018-3803
US

V. Phone/Fax

Practice location:
  • Phone: 917-484-0887
  • Fax:
Mailing address:
  • Phone: 917-484-0887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number003039
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number020372
License Number StateNY

VIII. Authorized Official

Name: RUSSELL STRAM
Title or Position: OWNER
Credential: PT, LAC.
Phone: 917-484-0887