Provider Demographics
NPI:1609165422
Name:TOTAL HEALTH ACUPUNCTURE & MASSAGE THERAPY, PLLC
Entity Type:Organization
Organization Name:TOTAL HEALTH ACUPUNCTURE & MASSAGE THERAPY, PLLC
Other - Org Name:TOTAL HEALTH ACUPUNCTURE & MASSAGE THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LIKUN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, LMT
Authorized Official - Phone:516-690-0027
Mailing Address - Street 1:156 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-7900
Mailing Address - Country:US
Mailing Address - Phone:631-647-7194
Mailing Address - Fax:631-647-7196
Practice Address - Street 1:156 4TH AVE
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-7900
Practice Address - Country:US
Practice Address - Phone:631-647-7194
Practice Address - Fax:631-647-7196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002948171100000X
NY014918225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty