Healthcare Provider Details

I. General information

NPI: 1013524867
Provider Name (Legal Business Name): GOLDEN ACUPUNCTURE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2020
Last Update Date: 09/25/2020
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22422 MERRICK BLVD
LAURELTON NY
11413-2023
US

IV. Provider business mailing address

5107 OCEAN VIEW AVE
BROOKLYN NY
11224-1115
US

V. Phone/Fax

Practice location:
  • Phone: 347-270-8353
  • Fax: 347-826-1917
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: OLGA GUSAKOV
Title or Position: ACUPUNCTURIST
Credential:
Phone: 347-204-3450