MEDICARE: MIMOSA ACUPUNCTURE PC

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	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1679696025
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIMOSA ACUPUNCTURE PC

Provider Business Mailing Address
First Line	:	9701 101ST AVE
Second Line	:
City	:	OZONE PARK
State	:	NY
Zip	:	11416-2523
Country	:	US
Telephone Number	:	718-835-3529
Fax Number	:

Provider Business Practice Location Address
First Line	:	9701 101ST AVE
Second Line	:
City	:	OZONE PARK
State	:	NY
Zip	:	11416-2523
Country	:	US
Telephone Number	:	718-835-3529
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSEPH A. RAIA
Credential	:	MD
Telephone Number	:	718-835-3529

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	09/18/2025

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