Provider Demographics
NPI:1972071223
Name:GOTHAM HOLISTIC INC
Entity type:Organization
Organization Name:GOTHAM HOLISTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHENG
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, LMT
Authorized Official - Phone:646-255-1332
Mailing Address - Street 1:39 W 14TH ST. SUITE 502
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-7403
Mailing Address - Country:US
Mailing Address - Phone:646-255-1332
Mailing Address - Fax:
Practice Address - Street 1:39 W 14TH ST. SUITE 502
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7403
Practice Address - Country:US
Practice Address - Phone:646-255-1332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-05
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty