Provider Demographics
NPI:1922777978
Name:WUNDELICH, DANIEL VINCENT (DACM, LAC, LMT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:VINCENT
Last Name:WUNDELICH
Suffix:
Gender:M
Credentials:DACM, LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 E 10TH ST
Mailing Address - Street 2:STE 1F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-5105
Mailing Address - Country:US
Mailing Address - Phone:212-466-0806
Mailing Address - Fax:212-466-0807
Practice Address - Street 1:70 E 10TH ST
Practice Address - Street 2:STE 1F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-5105
Practice Address - Country:US
Practice Address - Phone:212-466-0806
Practice Address - Fax:212-466-0807
Is Sole Proprietor?:No
Enumeration Date:2021-09-12
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY16598225700000X
NY3250171100000X
FLMA101241225700000X
FLAP4396171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist