Healthcare Provider Details

I. General information

NPI: 1265246433
Provider Name (Legal Business Name): JIC ACUPUNCTURE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2025
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14205 ROOSEVELT AVE STE 134
FLUSHING NY
11354-6001
US

IV. Provider business mailing address

3640 MAIN ST STE 202
FLUSHING NY
11354-6521
US

V. Phone/Fax

Practice location:
  • Phone: 917-992-8836
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JESSICA CHANG
Title or Position: PRESIDENT
Credential:
Phone: 917-992-8836