Healthcare Provider Details

I. General information

NPI: 1255823563
Provider Name (Legal Business Name): TEAM ACUPUNCTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2018
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 FAIRVIEW AVE
EASTON PA
18042-3915
US

IV. Provider business mailing address

2001 FAIRVIEW AVE
EASTON PA
18042-3915
US

V. Phone/Fax

Practice location:
  • Phone: 484-935-3253
  • Fax:
Mailing address:
  • Phone: 484-935-3253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberOM000232
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY MCCORMICK
Title or Position: OWNER
Credential:
Phone: 610-442-9173