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General NPI Number Information
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NPI Number | 1528575016
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Entity Type | Organization
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Legal Business Name | HEAVENLY WELL P.C.
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Dates
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Enumeration Date | 01/05/2018
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Last Update Date | 06/28/2023
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Provider Practice Location Address
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Address Line | 101 N 10TH ST APT 304
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City | BROOKLYN
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State | NY
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Zip | 11249-1910
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Country | US
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Telephone | 917-446-9868
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Fax |
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Provider Business Mailing Address
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Address Line | 101 N 10TH ST APT 304
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City | BROOKLYN
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State | NY
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Zip | 11249-1910
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Country | US
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Telephone | 718-930-2219
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BART ALLAN BECKERMANN
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Credential | L.AC.
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Telephone | 718-930-2219
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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 | 005057
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License Number State | NY
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