MEDICARE: ENERGETIC MEDICAL, 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	212598	NY

General Provider Information

NPI Number	:	1932624749
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENERGETIC MEDICAL, PC

Provider Business Mailing Address
First Line	:	15114 22ND AVE
Second Line	:
City	:	WHITESTONE
State	:	NY
Zip	:	11357-3719
Country	:	US
Telephone Number	:	646-644-8889
Fax Number	:	718-888-7172

Provider Business Practice Location Address
First Line	:	4233 KISSENA BLVD STE 1A
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11355-3238
Country	:	US
Telephone Number	:	718-888-7122
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. LIHUA MO
Credential	:	MD
Telephone Number	:	718-888-7122

Provider Enumeration Date	:	08/14/2017
Last Update Date	:	08/14/2017

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