Healthcare Provider Details

I. General information

NPI: 1487889788
Provider Name (Legal Business Name): INTEGRATIVE ACUPUNCTURE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2009
Last Update Date: 09/09/2022
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 E 10TH ST STE 1F
NEW YORK NY
10003-5105
US

IV. Provider business mailing address

70 E 10TH ST STE 1F
NEW YORK NY
10003-5105
US

V. Phone/Fax

Practice location:
  • Phone: 212-466-0806
  • Fax: 212-466-0807
Mailing address:
  • Phone: 212-466-0806
  • Fax: 212-466-0807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number3250
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number16598
License Number StateNY

VIII. Authorized Official

Name: DR. DANIEL V WUNDERLICH
Title or Position: OWNER
Credential: DACM, LAC, LMT
Phone: 212-466-0806