Provider Demographics
NPI:1467889501
Name:THERAPEUTIC ACUPUNCTURE WELLNESS PLLC
Entity Type:Organization
Organization Name:THERAPEUTIC ACUPUNCTURE WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:L,AC., PTA/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DOREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RISER
Authorized Official - Suffix:
Authorized Official - Credentials:LAC,PTA
Authorized Official - Phone:914-301-0003
Mailing Address - Street 1:19 NORTH SALEM ROAD
Mailing Address - Street 2:PO BOX 396
Mailing Address - City:CROSS RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10518
Mailing Address - Country:US
Mailing Address - Phone:914-301-0003
Mailing Address - Fax:321-610-7496
Practice Address - Street 1:19 NORTH SALEM ROAD
Practice Address - Street 2:
Practice Address - City:CROSS RIVER
Practice Address - State:NY
Practice Address - Zip Code:10518
Practice Address - Country:US
Practice Address - Phone:914-301-0003
Practice Address - Fax:321-610-7496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003438261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center