Healthcare Provider Details

I. General information

NPI: 1417047523
Provider Name (Legal Business Name): JIAN HE L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MR. MICHAEL JIAN HE

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 E MAIN ST SUITE 302
MOUNT KISCO NY
10549-3027
US

IV. Provider business mailing address

25 DEER RIDGE RD
BEDFORD CORNERS NY
10549-4200
US

V. Phone/Fax

Practice location:
  • Phone: 914-666-0100
  • Fax:
Mailing address:
  • Phone: 917-855-9711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number000848
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: