Provider Demographics
NPI:1205340254
Name:BED STUY ACUPUNCTURE AND MASSAGE THERAPY PLLC
Entity type:Organization
Organization Name:BED STUY ACUPUNCTURE AND MASSAGE THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SENIOR ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:O'NEAL
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:917-282-7208
Mailing Address - Street 1:1069 BEDFORD AVE STOREFRONT
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-4793
Mailing Address - Country:US
Mailing Address - Phone:862-252-1230
Mailing Address - Fax:
Practice Address - Street 1:1069 BEDFORD AVE STOREFRONT
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216
Practice Address - Country:US
Practice Address - Phone:862-252-1230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003500171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty