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General NPI Number Information
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NPI Number | 1124492228
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Entity Type | Organization
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Legal Business Name | ACUBALANCE WELLNESS OF LONG ISLAND LLC
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Dates
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Enumeration Date | 11/30/2015
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Last Update Date | 11/30/2015
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Provider Practice Location Address
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Address Line | 1482 WAGNER ST
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City | WANTAGH
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State | NY
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Zip | 11793-3043
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Country | US
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Telephone | 516-491-5309
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Fax |
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Provider Business Mailing Address
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Address Line | 1482 WAGNER ST
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City | WANTAGH
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State | NY
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Zip | 11793-3043
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Country | US
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Telephone | 516-491-5309
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Fax |
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Authorized Official
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Title or Position | LICENSED ACUPUNCTURIST
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Name | TERESA SINCLAIR
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Credential | L.AC
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Telephone | 516-491-5309
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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 | 005647-1
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License Number State | NY
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