Provider Demographics
NPI:1487173555
Name:GROUNDED ACUPUNCTURE, PLLC
Entity type:Organization
Organization Name:GROUNDED ACUPUNCTURE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:319-230-7221
Mailing Address - Street 1:415 ARGYLE ROAD
Mailing Address - Street 2:3S
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218
Mailing Address - Country:US
Mailing Address - Phone:319-230-7221
Mailing Address - Fax:
Practice Address - Street 1:80 8TH AVE STE 1304
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7161
Practice Address - Country:US
Practice Address - Phone:212-634-7686
Practice Address - Fax:212-634-7686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-11
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006025171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY153-869-9616OtherNPI