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General NPI Number Information
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NPI Number | 1467889501
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Entity Type | Organization
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Legal Business Name | THERAPEUTIC ACUPUNCTURE WELLNESS PLLC
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Dates
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Enumeration Date | 10/03/2013
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Last Update Date | 10/03/2013
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Provider Practice Location Address
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Address Line | 19 NORTH SALEM ROAD
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City | CROSS RIVER
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State | NY
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Zip | 10518
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Country | US
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Telephone | 914-301-0003
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Fax | 321-610-7496
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Provider Business Mailing Address
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Address Line | 19 NORTH SALEM ROAD PO BOX 396
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City | CROSS RIVER
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State | NY
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Zip | 10518
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Country | US
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Telephone | 914-301-0003
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Fax | 321-610-7496
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Authorized Official
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Title or Position | L,AC., PTA/OWNER
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Name | MS. DOREEN RISER
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Credential | L.AC.,PTA
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Telephone | 914-301-0003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 003438
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License Number State | NY
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