Provider Demographics
NPI:1003385147
Name:THIRD ROOT ACUPUNCTURE & MASSAGE, PLLC
Entity Type:Organization
Organization Name:THIRD ROOT ACUPUNCTURE & MASSAGE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-940-9343
Mailing Address - Street 1:380 MARLBOROUGH RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-5618
Mailing Address - Country:US
Mailing Address - Phone:718-940-9343
Mailing Address - Fax:
Practice Address - Street 1:380 MARLBOROUGH RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-5618
Practice Address - Country:US
Practice Address - Phone:718-940-9343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty