Provider Demographics
NPI:1871045195
Name:SHOLISTIC ACUPUNCTURE INC
Entity Type:Organization
Organization Name:SHOLISTIC ACUPUNCTURE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:ISME
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, RN
Authorized Official - Phone:917-557-3837
Mailing Address - Street 1:487 BALDWIN PATH
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-1416
Mailing Address - Country:US
Mailing Address - Phone:917-557-3837
Mailing Address - Fax:631-752-1659
Practice Address - Street 1:6 WESTON ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-4031
Practice Address - Country:US
Practice Address - Phone:917-557-3837
Practice Address - Fax:631-752-1659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005605-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty