=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023694593
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRISM ACUPUNTURE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2021
-----------------------------------------------------
Last Update Date | 02/15/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 344 JERICHO TPKE APT 1
-----------------------------------------------------
City | FLORAL PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11001-2166
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-497-3039
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 373 PLAINFIELD AVE
-----------------------------------------------------
City | FLORAL PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11001-3053
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-376-9743
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | CHRISTINA BARR
-----------------------------------------------------
Credential | LAC
-----------------------------------------------------
Telephone | 516-497-3039
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------