Provider Demographics
NPI:1013618164
Name:INTEGRATED ACUPUNCTURE WELLNESS PLLC
Entity Type:Organization
Organization Name:INTEGRATED ACUPUNCTURE WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:ACUPUNCTURE
Authorized Official - Phone:201-206-2006
Mailing Address - Street 1:2 MEDICAL PARK DR STE 7
Mailing Address - Street 2:
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-1966
Mailing Address - Country:US
Mailing Address - Phone:845-688-1030
Mailing Address - Fax:
Practice Address - Street 1:2 MEDICAL PARK DR STE 7
Practice Address - Street 2:
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-1966
Practice Address - Country:US
Practice Address - Phone:201-206-2006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-15
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty