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General NPI Number Information
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NPI Number | 1053919662
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Entity Type | Organization
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Legal Business Name | INTEGRATED WELLNESS MASSAGE THERAPY AND ACUPUNCTURE PLLC
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Dates
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Enumeration Date | 10/15/2020
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Last Update Date | 10/15/2020
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Provider Practice Location Address
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Address Line | 160 OLD COUNTRY RD
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City | RIVERHEAD
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State | NY
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Zip | 11901-2198
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Country | US
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Telephone | 516-971-5435
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Fax |
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Provider Business Mailing Address
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Address Line | 3475 HEMPSTEAD TPKE STE 2
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City | LEVITTOWN
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State | NY
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Zip | 11756-1411
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Country | US
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Telephone | 516-796-2400
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHRISTOPHER POPP
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Credential |
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Telephone | 516-971-5435
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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 |
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License Number State |
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