Healthcare Provider Details

I. General information

NPI: 1720229271
Provider Name (Legal Business Name): RICHARD JYAN ACUPUNCTURIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2009
Last Update Date: 03/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5819 262ND ST
LITTLE NECK NY
11362-2514
US

IV. Provider business mailing address

5819 262ND ST
LITTLE NECK NY
11362-2514
US

V. Phone/Fax

Practice location:
  • Phone: 718-631-1468
  • Fax: 718-228-6592
Mailing address:
  • Phone: 718-631-1468
  • Fax: 718-228-6592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number003940
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: