Provider Demographics
NPI:1477019958
Name:ESOTERRA ACUPUNCTURE PC
Entity Type:Organization
Organization Name:ESOTERRA ACUPUNCTURE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ENENSAAUAS
Authorized Official - Middle Name:
Authorized Official - Last Name:RASTRYGINA
Authorized Official - Suffix:
Authorized Official - Credentials:DAC
Authorized Official - Phone:833-768-3772
Mailing Address - Street 1:19 W 45 ST
Mailing Address - Street 2:STE 501
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036
Mailing Address - Country:US
Mailing Address - Phone:833-768-3772
Mailing Address - Fax:
Practice Address - Street 1:19 W 45 ST
Practice Address - Street 2:STE 501
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036
Practice Address - Country:US
Practice Address - Phone:833-768-3772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty