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General NPI Number Information
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NPI Number | 1568876639
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Entity Type | Organization
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Legal Business Name | PHOENIX RISING ACUPUNCTURE
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Dates
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Enumeration Date | 06/17/2014
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Last Update Date | 06/17/2014
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Provider Practice Location Address
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Address Line | 149 COMMACK RD
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City | COMMACK
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State | NY
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Zip | 11725-3459
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Country | US
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Telephone | 631-352-2051
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Fax |
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Provider Business Mailing Address
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Address Line | 149 COMMACK RD
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City | COMMACK
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State | NY
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Zip | 11725-3459
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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 | DEAN K MONITTO
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Credential | MSOM
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Telephone | 631-352-2051
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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 | 005303
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License Number State | NY
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