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General NPI Number Information
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NPI Number | 1609165422
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Entity Type | Organization
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Legal Business Name | TOTAL HEALTH ACUPUNCTURE & MASSAGE THERAPY, PLLC
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Dates
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Enumeration Date | 04/01/2011
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Last Update Date | 04/01/2011
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Provider Practice Location Address
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Address Line | 156 4TH AVE
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City | BAY SHORE
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State | NY
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Zip | 11706-7900
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Country | US
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Telephone | 631-647-7194
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Fax | 631-647-7196
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Provider Business Mailing Address
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Address Line | 156 4TH AVE
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City | BAY SHORE
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State | NY
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Zip | 11706-7900
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Country | US
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Telephone | 631-647-7194
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Fax | 631-647-7196
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. LIKUN LEE
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Credential | L.AC., L.M.T.
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Telephone | 516-690-0027
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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 | 014918
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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 | 002948
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License Number State | NY
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