Healthcare Provider Details

I. General information

NPI: 1487108429
Provider Name (Legal Business Name): JANE CULLEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2016
Last Update Date: 08/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E 40TH ST APT. 6B
NEW YORK NY
10016-2188
US

IV. Provider business mailing address

300 E 40TH ST APT. 6B
NEW YORK NY
10016-2188
US

V. Phone/Fax

Practice location:
  • Phone: 917-913-1903
  • Fax:
Mailing address:
  • Phone: 917-913-1903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number004847-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number026250-1
License Number StateNY

VIII. Authorized Official

Name: MS. JANE CULLEY
Title or Position: OWNER
Credential: LAC,
Phone: 917-913-1903