Provider Demographics
NPI:1780149013
Name:INTEGRATIVE ACUPUNCTURE AND MASSAGE THERAPY, PLLC
Entity type:Organization
Organization Name:INTEGRATIVE ACUPUNCTURE AND MASSAGE THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SOLOUNIAS
Authorized Official - Suffix:
Authorized Official - Credentials:LAC,LMT
Authorized Official - Phone:516-312-6670
Mailing Address - Street 1:1211 STEWART AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-1601
Mailing Address - Country:US
Mailing Address - Phone:516-312-6670
Mailing Address - Fax:516-307-0318
Practice Address - Street 1:1211 STEWART AVE STE 104
Practice Address - Street 2:
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-1601
Practice Address - Country:US
Practice Address - Phone:516-312-6670
Practice Address - Fax:516-307-0318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-31
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty