Provider Demographics
NPI:1093226631
Name:WOODSTOCK HEALING ARTS, LLC
Entity Type:Organization
Organization Name:WOODSTOCK HEALING ARTS, LLC
Other - Org Name:WOODSTOCK HEALING ARTS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:FLEISHER
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, CZB
Authorized Official - Phone:917-723-3616
Mailing Address - Street 1:83 MILL HILL RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:NY
Mailing Address - Zip Code:12498-1303
Mailing Address - Country:US
Mailing Address - Phone:845-393-4325
Mailing Address - Fax:
Practice Address - Street 1:83 MILL HILL RD
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:NY
Practice Address - Zip Code:12498-1303
Practice Address - Country:US
Practice Address - Phone:845-393-4325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000403-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty