Healthcare Provider Details

I. General information

NPI: 1093284341
Provider Name (Legal Business Name): PRESENT SAGE ACUPUNCTURE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2018
Last Update Date: 11/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 MONTGOMERY AVE STE 316
NARBERTH PA
19072-1948
US

IV. Provider business mailing address

822 MONTGOMERY AVE STE 316
NARBERTH PA
19072-1948
US

V. Phone/Fax

Practice location:
  • Phone: 215-680-2362
  • Fax:
Mailing address:
  • Phone: 215-680-2362
  • 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: MARY FATIMAH WEENING
Title or Position: LICENSED ACUPUNCTURIST
Credential: L.AC. DIPL.AC.
Phone: 215-680-2362