Provider Demographics
NPI:1043978059
Name:CHRISTINA WALLACE ACUPUNCTURE PLLC
Entity Type:Organization
Organization Name:CHRISTINA WALLACE ACUPUNCTURE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:914-246-0148
Mailing Address - Street 1:916 LYMAN AVE
Mailing Address - Street 2:
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-1820
Mailing Address - Country:US
Mailing Address - Phone:914-246-0148
Mailing Address - Fax:
Practice Address - Street 1:200 S. BROADWAY
Practice Address - Street 2:SOUTH BUILDING, SUITE #2-3
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-4500
Practice Address - Country:US
Practice Address - Phone:914-246-0148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty