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General NPI Number Information
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NPI Number | 1942549753
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Entity Type | Organization
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Legal Business Name | WELLNESS PLAZA ACUPUNCTURE P.C
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Dates
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Enumeration Date | 02/14/2013
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Last Update Date | 02/14/2013
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Provider Practice Location Address
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Address Line | 1021 AVENUE Z
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City | BROOKLYN
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State | NY
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Zip | 11235-5105
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Country | US
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Telephone | 718-769-7191
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Fax |
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Provider Business Mailing Address
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Address Line | 1021 AVENUE Z
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City | BROOKLYN
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State | NY
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Zip | 11235-5105
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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 | PRESIDENT
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Name | PETER KOPACH
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Credential | LAC
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Telephone | 718-769-7191
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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 | 002967
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License Number State | NY
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