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General NPI Number Information
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NPI Number | 1306557533
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Entity Type | Organization
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Legal Business Name | EARTH SKY MASSAGE AND ACUPUNCTURE
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Dates
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Enumeration Date | 12/08/2022
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Last Update Date | 12/08/2022
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Provider Practice Location Address
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Address Line | 531 50TH AVE
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City | LONG ISLAND CITY
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State | NY
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Zip | 11101-6297
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Country | US
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Telephone | 917-725-0299
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Fax |
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Provider Business Mailing Address
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Address Line | 531 50TH AVE
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City | LONG ISLAND CITY
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State | NY
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Zip | 11101-6297
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Country | US
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Telephone | 917-725-0299
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KENNA BOUVET
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Credential | LAC
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Telephone | 269-223-2496
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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