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General NPI Number Information
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NPI Number | 1437545589
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Entity Type | Organization
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Legal Business Name | LIBERTY ACUPUNCTURE & WELLNESS, PC
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Dates
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Enumeration Date | 04/15/2015
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Last Update Date | 04/15/2015
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Provider Practice Location Address
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Address Line | 520 FRANKLIN AVE STE L2
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City | GARDEN CITY
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State | NY
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Zip | 11530-5813
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Country | US
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Telephone | 516-280-6600
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1191
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City | SYOSSET
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State | NY
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Zip | 11791-0904
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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 | PRESIDENT
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Name | JOSH LEE
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Credential | PHD
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Telephone | 516-376-3703
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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 | 003470
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License Number State | NY
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