Healthcare Provider Details

I. General information

NPI: 1306587316
Provider Name (Legal Business Name): BEYOND WELLNESS MASSAGE THERAPY AND ACUPUNCTURE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 04/05/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 6TH ST SUITE / APT #
WEST BABYLON NY
11704
US

IV. Provider business mailing address

410 6TH ST SUITE / APT #
WEST BABYLON NY
11704
US

V. Phone/Fax

Practice location:
  • Phone: 631-991-3600
  • Fax:
Mailing address:
  • Phone: 631-991-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSHUA L GUTIERREZ
Title or Position: ACUPUNCTURIST
Credential: DAC
Phone: 631-481-6478