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General NPI Number Information
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NPI Number | 1619340015
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Entity Type | Organization
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Legal Business Name | INNOVATIVE ACUPUNCTURE, PLLC
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Dates
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Enumeration Date | 11/06/2015
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Last Update Date | 11/06/2015
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Provider Practice Location Address
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Address Line | 395 FRANKLIN AVE
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City | FRANKLIN SQUARE
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State | NY
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Zip | 11010-1227
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Country | US
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Telephone | 516-816-3171
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Fax |
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Provider Business Mailing Address
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Address Line | 853 PEPPERIDGE RD
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City | WESTBURY
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State | NY
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Zip | 11590-1418
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Country | US
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Telephone | 516-816-3171
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Fax |
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Authorized Official
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Title or Position | LICENSED ACUPUNCTURIST
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Name | MICHELE GLISPY
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Credential |
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Telephone | 516-816-3171
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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 |
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License Number State |
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