Healthcare Provider Details

I. General information

NPI: 1861165599
Provider Name (Legal Business Name): NY STATE ACUPUNCTURE WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2021
Last Update Date: 07/28/2021
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 MILTON RD
RYE NY
10580-3812
US

IV. Provider business mailing address

145 MILTON RD
RYE NY
10580-3812
US

V. Phone/Fax

Practice location:
  • Phone: 845-362-8400
  • Fax: 845-362-8474
Mailing address:
  • Phone: 845-362-8400
  • Fax: 845-362-8474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: HAROLDO JEZLER
Title or Position: OWNER
Credential: LAC
Phone: 800-750-8616