Healthcare Provider Details

I. General information

NPI: 1770120966
Provider Name (Legal Business Name): THREE VILLAGE ACUPUNCTURE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2019
Last Update Date: 06/19/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S JERSEY AVE UNIT 2
EAST SETAUKET NY
11733-2035
US

IV. Provider business mailing address

100 S JERSEY AVE UNIT 2
EAST SETAUKET NY
11733-2035
US

V. Phone/Fax

Practice location:
  • Phone: 631-941-3232
  • Fax:
Mailing address:
  • Phone: 631-941-3232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: MR. WEIGUO ZHANG
Title or Position: OWNER
Credential:
Phone: 631-941-3232