Provider Demographics
NPI:1558921957
Name:ROOTS MINDFUL ACUPUNCTURE PLLC
Entity Type:Organization
Organization Name:ROOTS MINDFUL ACUPUNCTURE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHIKO
Authorized Official - Middle Name:
Authorized Official - Last Name:YOSHIFUJI
Authorized Official - Suffix:
Authorized Official - Credentials:DIPL AC, LAC
Authorized Official - Phone:631-379-2583
Mailing Address - Street 1:20560 BRIAN CRES FL 3
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1142
Mailing Address - Country:US
Mailing Address - Phone:631-379-2583
Mailing Address - Fax:631-967-1677
Practice Address - Street 1:4 W 43RD ST STE 603
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-7408
Practice Address - Country:US
Practice Address - Phone:631-379-2583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty