=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861204166
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ONE SOUND BODY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2025
-----------------------------------------------------
Last Update Date | 01/23/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 340 WHEATLEY PLZ STE B
-----------------------------------------------------
City | GREENVALE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11548-1339
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-351-2350
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 340 WHEATLEY PLZ STE B
-----------------------------------------------------
City | GREENVALE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11548-1339
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-351-2350
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | STEPHEN WICKES
-----------------------------------------------------
Credential | RD, CDN
-----------------------------------------------------
Telephone | 516-351-2350
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------