Provider Demographics
NPI:1073000584
Name:MIRANDA ACUPUNCTURE & MASSAGE PLLC
Entity Type:Organization
Organization Name:MIRANDA ACUPUNCTURE & MASSAGE PLLC
Other - Org Name:NY-CHI STUDIOS ACUPUNCTURE & MASSAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:LAC LMT
Authorized Official - Phone:516-974-1527
Mailing Address - Street 1:535 S BROADWAY STE 4
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-5029
Mailing Address - Country:US
Mailing Address - Phone:516-595-7541
Mailing Address - Fax:516-595-7543
Practice Address - Street 1:535 S BROADWAY STE 4
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-5029
Practice Address - Country:US
Practice Address - Phone:516-595-7541
Practice Address - Fax:516-595-7543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-19
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
004337171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty