Provider Demographics
NPI:1760025233
Name:INTEGRATIVE FAMILY ACUPUNCTURE & MASSAGE THERAPY PLLC
Entity Type:Organization
Organization Name:INTEGRATIVE FAMILY ACUPUNCTURE & MASSAGE THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
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:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty