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General NPI Number Information
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NPI Number | 1033499355
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Entity Type | Organization
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Legal Business Name | SAYVILLE THERAPEUTIC SPA INC
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Dates
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Enumeration Date | 08/17/2011
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Last Update Date | 08/17/2011
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Provider Practice Location Address
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Address Line | 120 MAIN ST
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City | SAYVILLE
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State | NY
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Zip | 11782-2504
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Country | US
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Telephone | 631-563-8955
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Fax | 631-563-1824
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Provider Business Mailing Address
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Address Line | 120 MAIN ST
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City | SAYVILLE
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State | NY
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Zip | 11782-2504
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Country | US
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Telephone | 631-563-8955
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Fax | 631-563-1824
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | WIESLAWA MALISZEWSKI
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Credential | L.AC, LMT
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Telephone | 631-563-8955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 004279-1
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License Number State | NY
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