Healthcare Provider Details

I. General information

NPI: 1922777978
Provider Name (Legal Business Name): DANIEL VINCENT WUNDERLICH DACM, LAC, LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2021
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
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 TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP4396
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number16598
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA101241
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number3250
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: