Provider Demographics
NPI:1386316461
Name:ANDERSENACU INC
Entity type:Organization
Organization Name:ANDERSENACU INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARISA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-355-9763
Mailing Address - Street 1:354 VETERANS MEMORIAL HWY STE 1
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-4331
Mailing Address - Country:US
Mailing Address - Phone:631-326-4286
Mailing Address - Fax:
Practice Address - Street 1:354 VETERANS MEMORIAL HWY STE 1
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-4331
Practice Address - Country:US
Practice Address - Phone:631-326-4286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty