Healthcare Provider Details

I. General information

NPI: 1831069251
Provider Name (Legal Business Name): JEANNY S KOO L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 S MIDDLETOWN RD
NANUET NY
10954-3327
US

IV. Provider business mailing address

480 PATERSON AVE APT 307
EAST RUTHERFORD NJ
07073-1238
US

V. Phone/Fax

Practice location:
  • Phone: 845-379-9000
  • Fax: 845-330-4688
Mailing address:
  • Phone: 201-527-8080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number007806-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: