Healthcare Provider Details

I. General information

NPI: 1497951214
Provider Name (Legal Business Name): TETYANA VASYLENKO L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 08/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 PARKWAY AVE SUITE 9
EWING NJ
08628-3006
US

IV. Provider business mailing address

2088 OLD WELSH RD
ABINGTON PA
19001
US

V. Phone/Fax

Practice location:
  • Phone: 609-771-6192
  • Fax: 609-771-6874
Mailing address:
  • Phone: 215-658-4917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25MZ00048800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAK000819
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: