MEDICARE: WISDOM HOUSE NEW YORK, INC.

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	1376	NY

General Provider Information

NPI Number	:	1326478306
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WISDOM HOUSE NEW YORK, INC.

Provider Business Mailing Address
First Line	:	200 W 57TH ST STE 1010
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10019-3215
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 W 57TH ST STE 1010
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10019-3215
Country	:	US
Telephone Number	:	212-245-0336
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. JEAN MENGES
Credential	:
Telephone Number	:	212-245-0336

Provider Enumeration Date	:	11/12/2013
Last Update Date	:	11/12/2013

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