Provider Demographics
NPI:1528575016
Name:HEAVENLY WELL P.C.
Entity Type:Organization
Organization Name:HEAVENLY WELL P.C.
Other - Org Name:ACUPUNCTURE WILLIAMSBURG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BART
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:BECKERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:718-930-2219
Mailing Address - Street 1:101 N 10TH ST APT 304
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11249-1910
Mailing Address - Country:US
Mailing Address - Phone:718-930-2219
Mailing Address - Fax:
Practice Address - Street 1:101 N 10TH ST APT 304
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11249-1910
Practice Address - Country:US
Practice Address - Phone:917-446-9868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-05
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005057171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty