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General NPI Number Information
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NPI Number | 1952732075
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Entity Type | Organization
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Legal Business Name | AM ACUPUNCTURE & MASSAGE PC
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Dates
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Enumeration Date | 11/30/2013
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Last Update Date | 11/30/2013
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Provider Practice Location Address
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Address Line | 4 LANDVIEW DR
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City | KINGS PARK
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State | NY
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Zip | 11754-2827
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Country | US
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Telephone | 631-278-0654
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Fax |
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Provider Business Mailing Address
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Address Line | 4 LANDVIEW DR
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City | KINGS PARK
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State | NY
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Zip | 11754-2827
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Country | US
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Telephone | 631-278-0654
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. ANDRE MISSO
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Credential | L AC. L.M.T.
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Telephone | 631-278-0654
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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 | 004784
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License Number State | NY
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