Healthcare Provider Details

I. General information

NPI: 1972203057
Provider Name (Legal Business Name): YING JIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2023
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

466 S MARGINAL RD
JERICHO NY
11753-1916
US

IV. Provider business mailing address

466 S MARGINAL RD
JERICHO NY
11753-1916
US

V. Phone/Fax

Practice location:
  • Phone: 917-496-5713
  • Fax:
Mailing address:
  • Phone: 917-496-5713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number034021
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number007272
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: