Provider Demographics
NPI:1962155820
Name:ADVANCED ACUPUNCTURE OF LONG ISLAND
Entity type:Organization
Organization Name:ADVANCED ACUPUNCTURE OF LONG ISLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DRAGOTTO
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:631-833-9996
Mailing Address - Street 1:4 STONE GATE CT
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-1567
Mailing Address - Country:US
Mailing Address - Phone:631-833-9996
Mailing Address - Fax:
Practice Address - Street 1:363 ROUTE 111 STE LL5
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-4767
Practice Address - Country:US
Practice Address - Phone:631-656-0828
Practice Address - Fax:631-382-4082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty