MEDICARE: INTEGRATIVE ACUPUNCTURE, PLLC

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	225700000X	Massage Therapist	16598	NY
2	171100000X	Acupuncturist	3250	NY

General Provider Information

NPI Number	:	1487889788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATIVE ACUPUNCTURE, PLLC

Provider Business Mailing Address
First Line	:	70 E 10TH ST
Second Line	:	STE 1F
City	:	NEW YORK
State	:	NY
Zip	:	10003-5105
Country	:	US
Telephone Number	:	212-466-0806
Fax Number	:	212-466-0807

Provider Business Practice Location Address
First Line	:	70 E 10TH ST
Second Line	:	STE 1F
City	:	NEW YORK
State	:	NY
Zip	:	10003-5105
Country	:	US
Telephone Number	:	212-466-0806
Fax Number	:	212-466-0807

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DANIEL V WUNDERLICH
Credential	:	DACM, LAC, LMT
Telephone Number	:	212-466-0806

Provider Enumeration Date	:	05/16/2009
Last Update Date	:	09/09/2022

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