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General NPI Number Information
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NPI Number | 1376909754
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Entity Type | Organization
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Legal Business Name | PEARL RIVER ACUPUNCTURE
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Dates
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Enumeration Date | 01/14/2016
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Last Update Date | 01/14/2016
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Provider Practice Location Address
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Address Line | 180 E CENTRAL AVE
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City | PEARL RIVER
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State | NY
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Zip | 10965-2537
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Country | US
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Telephone | 845-735-0800
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Fax | 845-735-0837
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Provider Business Mailing Address
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Address Line | 180 E CENTRAL AVE
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City | PEARL RIVER
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State | NY
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Zip | 10965-2537
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Country | US
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Telephone | 845-735-0800
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Fax | 845-735-0837
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Authorized Official
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Title or Position | OWNER
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Name | MR. RYAN A STEPHENS
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Credential | L.AC
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Telephone | 845-826-4772
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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 | 005677-1
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License Number State | NY
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