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General NPI Number Information
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NPI Number | 1972489961
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Entity Type | Organization
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Legal Business Name | PURE BODY THERAPEUTIC ACUPUNCTURE AND MASSAGE THERAPY PC
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Dates
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Enumeration Date | 08/14/2025
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 392 N WANTAGH AVE
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City | BETHPAGE
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State | NY
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Zip | 11714-4100
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Country | US
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Telephone | 631-949-4811
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Fax |
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Provider Business Mailing Address
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Address Line | 6700 192ND ST APT 412
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City | FRESH MEADOWS
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State | NY
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Zip | 11365-3735
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Country | US
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Telephone | 631-949-4811
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SUHYUN AHN
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Credential |
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Telephone | 917-915-1138
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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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 |
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License Number State |
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