Provider Demographics
NPI:1417475922
Name:DORI FORTUNATO ACUPUNCTURE AND MASSAGE THERAPY, PC
Entity Type:Organization
Organization Name:DORI FORTUNATO ACUPUNCTURE AND MASSAGE THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DORI
Authorized Official - Middle Name:
Authorized Official - Last Name:FORTUNATO
Authorized Official - Suffix:
Authorized Official - Credentials:DAOM
Authorized Official - Phone:631-237-1542
Mailing Address - Street 1:PO BOX 1647
Mailing Address - Street 2:
Mailing Address - City:BRIDGEHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11932-1647
Mailing Address - Country:US
Mailing Address - Phone:631-237-1542
Mailing Address - Fax:631-591-3140
Practice Address - Street 1:2228 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:BRIDGEHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11932-4001
Practice Address - Country:US
Practice Address - Phone:631-237-1542
Practice Address - Fax:631-591-3140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25005472171100000X
NY27027339225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty