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General NPI Number Information
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NPI Number | 1508630583
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Entity Type | Organization
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Legal Business Name | RADIANCE ACUPUNCTURE
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Dates
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Enumeration Date | 11/10/2023
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Last Update Date | 12/27/2023
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Provider Practice Location Address
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Address Line | 15 ECHO AVE
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City | MOUNT SINAI
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State | NY
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Zip | 11766-2000
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Country | US
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Telephone | 631-476-4855
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Fax |
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Provider Business Mailing Address
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Address Line | 110 TUDOR LN
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City | MIDDLE ISLAND
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State | NY
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Zip | 11953-1362
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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 | GAETANO PITTALA
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Credential |
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Telephone | 631-745-1009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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