Healthcare Provider Details

I. General information

NPI: 1093103426
Provider Name (Legal Business Name): EASTERN CURRENTS ACUPUNCTURE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2015
Last Update Date: 03/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 HILLCREST AVE
MANHASSET NY
11030-2316
US

IV. Provider business mailing address

2330 LINWOOD AVE APT 4F
FORT LEE NJ
07024-3862
US

V. Phone/Fax

Practice location:
  • Phone: 516-308-9119
  • Fax:
Mailing address:
  • Phone: 201-210-9553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number005222-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JAESUN LEE
Title or Position: OWNER/LICENSED ACUPUNCTURIST
Credential: L.AC
Phone: 201-210-9553