Provider Demographics
NPI:1861253833
Name:PAGODA ACUPUNCTURE WELLNESS PC
Entity type:Organization
Organization Name:PAGODA ACUPUNCTURE WELLNESS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ROMANO
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:631-205-6655
Mailing Address - Street 1:500 MONTAUK HWY STE T
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4420
Mailing Address - Country:US
Mailing Address - Phone:631-205-6655
Mailing Address - Fax:631-205-6654
Practice Address - Street 1:500 MONTAUK HWY STE T
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4420
Practice Address - Country:US
Practice Address - Phone:631-205-6655
Practice Address - Fax:631-205-6654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty