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General NPI Number Information
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NPI Number | 1730907189
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Entity Type | Organization
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Legal Business Name | SILVERPOINT SECRETS LLC
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Dates
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Enumeration Date | 10/02/2024
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 954 N BROADWAY
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City | MASSAPEQUA
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State | NY
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Zip | 11758-2360
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Country | US
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Telephone | 516-586-4364
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Fax |
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Provider Business Mailing Address
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Address Line | 278 N ATLANTA AVE
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City | MASSAPEQUA
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State | NY
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Zip | 11758-2011
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Country | US
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Telephone | 516-586-4364
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAWN ELIZABETH RISTAU
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Credential | L.AC
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Telephone | 516-586-4364
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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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