Healthcare Provider Details

I. General information

NPI: 1396320644
Provider Name (Legal Business Name): PLY ENTERPRISE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2021
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 SUMMER ST
NORTH BROOKFIELD MA
01535-1418
US

IV. Provider business mailing address

24 SUMMER ST
NORTH BROOKFIELD MA
01535-1418
US

V. Phone/Fax

Practice location:
  • Phone: 781-775-6928
  • Fax: 774-449-8074
Mailing address:
  • Phone: 781-775-6928
  • Fax: 774-449-8074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: PATRICK YEUNG
Title or Position: PRESIDENT
Credential: LAC
Phone: 781-775-6928