Healthcare Provider Details

I. General information

NPI: 1417460858
Provider Name (Legal Business Name): ELAINE CAO-ZHEN ACUPUNCTURIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2017
Last Update Date: 11/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 ATLANTIC AVE
EAST ROCKAWAY NY
11518-1431
US

IV. Provider business mailing address

17 OLIVER AVE
EDISON NJ
08820-3123
US

V. Phone/Fax

Practice location:
  • Phone: 516-295-5804
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number006102-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: