Healthcare Provider Details

I. General information

NPI: 1215793617
Provider Name (Legal Business Name): NY JAMESPORT ACUPUNCTURE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2024
Last Update Date: 02/23/2024
Certification Date: 02/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 N OCEAN AVE
PATCHOGUE NY
11772-2004
US

IV. Provider business mailing address

PO BOX 1206
JAMESPORT NY
11947-1206
US

V. Phone/Fax

Practice location:
  • Phone: 151-697-1698
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SCOT ALBERT CORTEZ
Title or Position: ACUPUNCTURIST/OWNER
Credential: L.AC
Phone: 516-971-6982