=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558017004
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EQUINOX ACUPUNCTURE WELLNESS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2022
-----------------------------------------------------
Last Update Date | 02/23/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 SARATOGA VILLAGE BLVD STE 37J
-----------------------------------------------------
City | MALTA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12020-3739
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-338-2533
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 515
-----------------------------------------------------
City | GREENFIELD CENTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12833-0515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/MANAGER
-----------------------------------------------------
Name | ELIZABETH LAURIN
-----------------------------------------------------
Credential | LAC
-----------------------------------------------------
Telephone | 518-338-2533
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------