Provider Demographics
NPI:1124777305
Name:FORGET ME NOT ACUPUNCTURE PC
Entity type:Organization
Organization Name:FORGET ME NOT ACUPUNCTURE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:GOUSSE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:631-257-5663
Mailing Address - Street 1:363 HAUPPAUGE RD, SUITE 97, NY-111
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787
Mailing Address - Country:US
Mailing Address - Phone:631-257-5663
Mailing Address - Fax:631-257-5664
Practice Address - Street 1:363 HAUPPAUGE RD, NY-111
Practice Address - Street 2:SUITE 97
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787
Practice Address - Country:US
Practice Address - Phone:631-257-5663
Practice Address - Fax:631-257-5664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty