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General NPI Number Information
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NPI Number | 1578807459
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Entity Type | Organization
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Legal Business Name | ALTCARE ACUPUNCTURE PLLC
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Dates
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Enumeration Date | 11/16/2012
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Last Update Date | 09/17/2019
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Provider Practice Location Address
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Address Line | 38 LANDING AVE
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City | SMITHTOWN
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State | NY
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Zip | 11787-2711
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Country | US
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Telephone | 631-708-3500
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Fax | 631-708-3505
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Provider Business Mailing Address
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Address Line | 38 LANDING AVE
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City | SMITHTOWN
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State | NY
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Zip | 11787-2711
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Country | US
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Telephone | 631-708-3500
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Fax | 631-708-3505
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANTHONY GORDON
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Credential | DAC., L.AC., LMT.
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Telephone | 631-708-3500
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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 | 019129
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License Number State | NY
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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 | 004558
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License Number State | NY
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