1992302087 NPI number — OPTIMUM HEALTH ACUPUNCTURE, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992302087 NPI number — OPTIMUM HEALTH ACUPUNCTURE, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPTIMUM HEALTH ACUPUNCTURE, P.C.
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:
1992302087
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6336 99TH ST FL 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REGO PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11374-1979
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-509-9424
Provider Business Mailing Address Fax Number:
718-509-9242

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1963 GRAND CONCOURSE FL 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10453-4995
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-509-9424
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/02/2020

Additional Information

Authorized Official

Authorized Official Last Name:
DOLSKY
Authorized Official First Name:
VADIM
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
718-974-3284

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)





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