Provider Demographics
NPI:1952732075
Name:AM ACUPUNCTURE & MASSAGE PC
Entity Type:Organization
Organization Name:AM ACUPUNCTURE & MASSAGE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:MISSO
Authorized Official - Suffix:
Authorized Official - Credentials:L AC LMT
Authorized Official - Phone:631-278-0654
Mailing Address - Street 1:4 LANDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-2827
Mailing Address - Country:US
Mailing Address - Phone:631-278-0654
Mailing Address - Fax:
Practice Address - Street 1:4 LANDVIEW DR
Practice Address - Street 2:
Practice Address - City:KINGS PARK
Practice Address - State:NY
Practice Address - Zip Code:11754-2827
Practice Address - Country:US
Practice Address - Phone:631-278-0654
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-30
Last Update Date:2013-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004784171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty