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General NPI Number Information
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NPI Number | 1871011585
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Entity Type | Organization
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Legal Business Name | LIFE ACUPUNCTURE & MASSAGE THERAPY P.C.
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Dates
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Enumeration Date | 09/01/2017
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Last Update Date | 09/01/2017
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Provider Practice Location Address
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Address Line | 387 EAST MAIN STREET SUITE 104
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City | BAYSHORE
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State | NY
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Zip | 11706
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Country | US
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Telephone | 516-633-8685
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Fax |
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Provider Business Mailing Address
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Address Line | P.O. BOX 157
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City | HOLTSVILLE
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State | NY
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Zip | 11742
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Country | US
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Telephone | 516-633-8685
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Fax | 631-654-7972
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | GERARD MAGGIO
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Credential | L. AC.
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Telephone | 516-633-8685
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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 | 002654
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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 | 003559
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License Number State | NY
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