Healthcare Provider Details

I. General information

NPI: 1710176227
Provider Name (Legal Business Name): ZHI YUAN ZHONG ACUPUNCTURIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2007
Last Update Date: 12/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 WALT WHITMAN RD STE 100A
HUNTINGTON STATION NY
11746-3631
US

IV. Provider business mailing address

23938 66TH AVE
LITTLE NECK NY
11362-1923
US

V. Phone/Fax

Practice location:
  • Phone: 631-271-3310
  • Fax: 631-271-3188
Mailing address:
  • Phone: 917-385-1567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number001607
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: