Provider Demographics
NPI:1548765688
Name:ACUPUNCTURE WELLNESS SERVICES, PLLC
Entity Type:Organization
Organization Name:ACUPUNCTURE WELLNESS SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTONDI
Authorized Official - Suffix:
Authorized Official - Credentials:DACM, LAC
Authorized Official - Phone:631-360-8100
Mailing Address - Street 1:872 MIDDLE COUNTRY RD STE 5
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-3223
Mailing Address - Country:US
Mailing Address - Phone:631-360-8100
Mailing Address - Fax:
Practice Address - Street 1:872 MIDDLE COUNTRY RD STE 5
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780-3223
Practice Address - Country:US
Practice Address - Phone:631-360-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty