MEDICARE: MISS NA WANG L.AC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	006157	NY
2	101YP2500X	Professional Counselor	006157	NY

General Provider Information

NPI Number	:	1811465156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS NA WANG L.AC

Provider Business Mailing Address
First Line	:	11 BROADWAY STE 336
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10004-1549
Country	:	US
Telephone Number	:	626-215-3602
Fax Number	:	212-361-0019

Provider Business Practice Location Address
First Line	:	6445 SPRINGFIELD BLVD
Second Line	:
City	:	BAYSIDE
State	:	NY
Zip	:	11364-2337
Country	:	US
Telephone Number	:	626-215-3602
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2018
Last Update Date	:	11/20/2019

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Directions to “ MISS NA WANG L.AC” Practice Location

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