Provider Demographics
NPI:1477878478
Name:INNER WISDOM, INC
Entity Type:Organization
Organization Name:INNER WISDOM, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARYROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:CABELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-570-4943
Mailing Address - Street 1:10322 PLATTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11417-2638
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10915 QUEENS BLVD
Practice Address - Street 2:72ND AVE
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-5482
Practice Address - Country:US
Practice Address - Phone:718-570-4943
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty