Organization
BAYSIDE ACUPUNCTURE & PHYSICAL THERAPY PLLC
Active
Organization
BAYSIDE ACUPUNCTURE & PHYSICAL THERAPY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIEVIC BALAAG EBORA FERNANDO PT (MANAGING MEMBER)
(718) 224-2250
Entity
Organization
Contact information
Practice address
20801 NORTHERN BLVD STE 301, BAYSIDE, NY 11361-3118
(718) 224-2250
(917) 398-1875
Mailing address
20801 NORTHERN BLVD STE 301, BAYSIDE, NY 11361-3118
(718) 224-2250
(917) 398-1875
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
005738
NY
225100000X
Physical Therapist
Primary
034901
NY
225700000X
Massage Therapist
027555
NY
Other
Enumeration date
06/04/2017
Last updated
07/21/2022
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