Provider Demographics
NPI:1114364874
Name:WILSEY SQ. ACUPUNCTURE AND MASSAGE LLC
Entity Type:Organization
Organization Name:WILSEY SQ. ACUPUNCTURE AND MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:O'NEILL
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:201-788-0394
Mailing Address - Street 1:285 PASCACK RD STE 4
Mailing Address - Street 2:
Mailing Address - City:TOWNSHIP OF WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07676-4841
Mailing Address - Country:US
Mailing Address - Phone:201-788-0294
Mailing Address - Fax:201-664-1485
Practice Address - Street 1:285 PASCACK RD STE 4
Practice Address - Street 2:
Practice Address - City:TOWNSHIP OF WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07676-4841
Practice Address - Country:US
Practice Address - Phone:201-788-0294
Practice Address - Fax:201-664-1485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-03
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00064600171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty