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General NPI Number Information
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NPI Number | 1932671286
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Entity Type | Organization
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Legal Business Name | FIVE BOROUGHS ACUPUNCTURE P C
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Dates
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Enumeration Date | 12/27/2018
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Last Update Date | 12/27/2018
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Provider Practice Location Address
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Address Line | 357 BROADWAY
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City | AMITYVILLE
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State | NY
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Zip | 11701-2748
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Country | US
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Telephone | 716-544-7303
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Fax |
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Provider Business Mailing Address
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Address Line | 456 BREESPORT RD
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City | HORSEHEADS
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State | NY
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Zip | 14845-9321
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | MR. ROBERT MATSCH
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Credential | LAC
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Telephone | 716-544-7303
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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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