1346719465 NPI number — NEW YORK FOUR SEASONS ACUPUNCTURE PC

Table of content: (NPI 1346719465)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346719465 NPI number — NEW YORK FOUR SEASONS ACUPUNCTURE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW YORK FOUR SEASONS ACUPUNCTURE PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346719465
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9217 71ST AVE STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOREST HILLS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11375-6706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-589-5723
Provider Business Mailing Address Fax Number:
347-766-0933

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9217 71ST AVE STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOREST HILLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11375-6706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-589-5723
Provider Business Practice Location Address Fax Number:
347-766-0933
Provider Enumeration Date:
11/19/2018

Additional Information

Authorized Official

Authorized Official Last Name:
FENG
Authorized Official First Name:
SERENE
Authorized Official Middle Name:
Authorized Official Title or Position:
ACUPUNCTURIST
Authorized Official Telephone Number:
646-651-6338

Provider Taxonomy Codes

  • Taxonomy code: 171100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 005649 . This is a "LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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