Healthcare Provider Details

I. General information

NPI: 1861768533
Provider Name (Legal Business Name): TARGET ACUPUNCTURE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 GRAND CONCOURSE
BRONX NY
10451-5409
US

IV. Provider business mailing address

334 GRAND CONCOURSE
BRONX NY
10451-5409
US

V. Phone/Fax

Practice location:
  • Phone: 718-590-5900
  • Fax:
Mailing address:
  • Phone: 718-590-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JIE SHI
Title or Position: PRESIDENT
Credential: L.AC
Phone: 516-906-1120