Provider Demographics
NPI:1205379849
Name:SUNDALA ON THE FARM INC.
Entity Type:Organization
Organization Name:SUNDALA ON THE FARM INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JODIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TASSELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-261-1495
Mailing Address - Street 1:103 S GREENBUSH RD
Mailing Address - Street 2:BUILDING 4
Mailing Address - City:ORANGEBURG
Mailing Address - State:NY
Mailing Address - Zip Code:10962-1322
Mailing Address - Country:US
Mailing Address - Phone:914-261-1495
Mailing Address - Fax:
Practice Address - Street 1:103 S GREENBUSH RD
Practice Address - Street 2:BUILDING 4
Practice Address - City:ORANGEBURG
Practice Address - State:NY
Practice Address - Zip Code:10962-1322
Practice Address - Country:US
Practice Address - Phone:914-261-1495
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-30
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004419171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty