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General NPI Number Information
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NPI Number | 1366890535
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Entity Type | Organization
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Legal Business Name | BLISS ACUPUNCTURE P.C.
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Dates
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Enumeration Date | 05/28/2016
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Last Update Date | 05/28/2016
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Provider Practice Location Address
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Address Line | 516 LAKEVILLE RD 516 LAKEVILLE ROAD
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-3006
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Country | US
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Telephone | 516-993-1416
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 769
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-0769
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JUSTIN WILFRED DOUGHERTY
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Credential | L.AC.
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Telephone | 516-993-1416
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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 | 005672
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License Number State | NY
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