MEDICARE: ACUPUNCTURE AND WELLNESS CENTER OF MIAMI BEACH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AP1191	FL

General Provider Information

NPI Number	:	1063784874
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACUPUNCTURE AND WELLNESS CENTER OF MIAMI BEACH

Provider Business Mailing Address
First Line	:	1030 NE 170TH TER
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-2666
Country	:	US
Telephone Number	:	786-554-2863
Fax Number	:

Provider Business Practice Location Address
First Line	:	1030 NE 170TH TER
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-2666
Country	:	US
Telephone Number	:	786-554-2863
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DANIEL ANDREW WASSERMAN
Credential	:	AP
Telephone Number	:	786-554-2863

Provider Enumeration Date	:	02/09/2012
Last Update Date	:	02/09/2012

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