Provider Demographics
NPI:1336772276
Name:ACUPUNCTURE TREE OF LIFE LLC
Entity Type:Organization
Organization Name:ACUPUNCTURE TREE OF LIFE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MAEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BETENVIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-573-1736
Mailing Address - Street 1:605 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06053-1652
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601 FARMINGTON AVE APT 1
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06053-5901
Practice Address - Country:US
Practice Address - Phone:860-573-8047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty