Healthcare Provider Details

I. General information

NPI: 1114241684
Provider Name (Legal Business Name): QUALITY ACUPUNCTURE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2010
Last Update Date: 01/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 LANDING AVE
SMITHTOWN NY
11787-2711
US

IV. Provider business mailing address

38 LANDING AVE
SMITHTOWN NY
11787-2711
US

V. Phone/Fax

Practice location:
  • Phone: 631-619-0369
  • Fax: 631-619-0368
Mailing address:
  • Phone: 631-619-0369
  • Fax: 631-619-0368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number3667
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number18268
License Number StateNY

VIII. Authorized Official

Name: MR. JORDAN BARBER
Title or Position: PRESIDENT
Credential: LAC.
Phone: 631-619-0369