Healthcare Provider Details

I. General information

NPI: 1346486669
Provider Name (Legal Business Name): MAI ACUPUNCTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2008
Last Update Date: 12/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 OLD COUNTRY RD
PLAINVIEW NY
11803-4938
US

IV. Provider business mailing address

62 ORCHID DR
KINGS PARK NY
11754-2215
US

V. Phone/Fax

Practice location:
  • Phone: 516-903-7019
  • 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: MR. MICHAEL IACOBELLIS
Title or Position: PRESIDENT
Credential:
Phone: 516-903-7019