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General NPI Number Information
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NPI Number | 1235657818
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Entity Type | Organization
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Legal Business Name | KNIGHTS OF WELLNESS
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Dates
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Enumeration Date | 09/05/2017
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Last Update Date | 09/05/2017
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Provider Practice Location Address
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Address Line | 119 N PARK AVE STE 301
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City | ROCKVILLE CENTRE
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State | NY
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Zip | 11570-4113
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Country | US
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Telephone | 516-557-3583
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Fax |
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Provider Business Mailing Address
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Address Line | 130 BAISLEY AVE
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City | EAST ROCKAWAY
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State | NY
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Zip | 11518-1824
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Country | US
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Telephone | 516-557-3583
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DOUGLAS I JOHNSON
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Credential | LMT LAC MS
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Telephone | 516-557-3583
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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 | 005953
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License Number State | NY
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