Provider Demographics
NPI:1477763068
Name:SMITHTOWN ACUPUNCTURE AND WELLNESS PC
Entity Type:Organization
Organization Name:SMITHTOWN ACUPUNCTURE AND WELLNESS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, LMT
Authorized Official - Phone:631-265-5656
Mailing Address - Street 1:24 GILBERT AVE
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-5310
Mailing Address - Country:US
Mailing Address - Phone:631-265-5656
Mailing Address - Fax:631-265-5660
Practice Address - Street 1:20 GILBERT AVE
Practice Address - Street 2:STE. 202
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-5326
Practice Address - Country:US
Practice Address - Phone:631-265-5656
Practice Address - Fax:631-265-5660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001316171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty