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General NPI Number Information
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NPI Number | 1780017079
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Entity Type | Organization
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Legal Business Name | POINT OF LIFE ACUPUNCTURE, P.C.
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Dates
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Enumeration Date | 08/09/2013
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Last Update Date | 08/09/2013
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Provider Practice Location Address
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Address Line | 166 BERGEN ST
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-2602
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Country | US
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Telephone | 631-525-2161
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Fax |
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Provider Business Mailing Address
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Address Line | 166 BERGEN ST
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-2602
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Country | US
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Telephone | 631-525-2161
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. RYDER J. CHAMPOUILLON
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Credential | MSOM, L.AC
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Telephone | 631-525-2161
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 0035731
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License Number State | NY
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