MEDICARE: ROOTS MINDFUL 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	171100000X	Acupuncturist

General Provider Information

NPI Number	:	1558921957
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROOTS MINDFUL ACUPUNCTURE PLLC

Provider Business Mailing Address
First Line	:	20560 BRIAN CRES FL 3
Second Line	:
City	:	BAYSIDE
State	:	NY
Zip	:	11360-1142
Country	:	US
Telephone Number	:	631-379-2583
Fax Number	:	631-967-1677

Provider Business Practice Location Address
First Line	:	4 W 43RD ST STE 603
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10036-7408
Country	:	US
Telephone Number	:	631-379-2583
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. MICHIKO YOSHIFUJI
Credential	:	DIPL. AC., L.AC.
Telephone Number	:	631-379-2583

Provider Enumeration Date	:	06/18/2019
Last Update Date	:	06/18/2019

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