Healthcare Provider Details

I. General information

NPI: 1053919662
Provider Name (Legal Business Name): INTEGRATED WELLNESS MASSAGE THERAPY AND ACUPUNCTURE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2020
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 OLD COUNTRY RD
RIVERHEAD NY
11901-2198
US

IV. Provider business mailing address

3475 HEMPSTEAD TPKE STE 2
LEVITTOWN NY
11756-1411
US

V. Phone/Fax

Practice location:
  • Phone: 516-971-5435
  • Fax:
Mailing address:
  • Phone: 516-796-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHRISTOPHER POPP
Title or Position: PRESIDENT
Credential:
Phone: 516-971-5435