Provider Demographics
NPI:1578807459
Name:ALTCARE ACUPUNCTURE PLLC
Entity Type:Organization
Organization Name:ALTCARE ACUPUNCTURE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:DAC, LAC, LMT
Authorized Official - Phone:631-708-3500
Mailing Address - Street 1:38 LANDING AVE
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2711
Mailing Address - Country:US
Mailing Address - Phone:631-708-3500
Mailing Address - Fax:631-708-3505
Practice Address - Street 1:38 LANDING AVE
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2711
Practice Address - Country:US
Practice Address - Phone:631-708-3500
Practice Address - Fax:631-708-3505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-16
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004558171100000X
NY019129225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty