Provider Demographics
NPI:1528217189
Name:RONALD SANDOVAL, ACUPUNCTURE, MASSAGE THERAPY, PC
Entity Type:Organization
Organization Name:RONALD SANDOVAL, ACUPUNCTURE, MASSAGE THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:O
Authorized Official - Last Name:SANDOVAL
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, LMT
Authorized Official - Phone:631-424-8601
Mailing Address - Street 1:1789 E JERICHO TPKE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-5765
Mailing Address - Country:US
Mailing Address - Phone:631-424-8601
Mailing Address - Fax:631-424-8603
Practice Address - Street 1:1789 E JERICHO TPKE
Practice Address - Street 2:SUITE 200
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-5765
Practice Address - Country:US
Practice Address - Phone:631-424-8601
Practice Address - Fax:631-424-8603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001938171100000X
NY009300225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty