Healthcare Provider Details

I. General information

NPI: 1043910375
Provider Name (Legal Business Name): JS ACUPUNCTURE & MASSAGE THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 LAKEVILLE RD
NEW HYDE PARK NY
11040-3006
US

IV. Provider business mailing address

516 LAKEVILLE RD
NEW HYDE PARK NY
11040-3006
US

V. Phone/Fax

Practice location:
  • Phone: 646-596-1858
  • Fax:
Mailing address:
  • Phone: 646-596-1858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: JOOWON SEO
Title or Position: MASSAGE THERAPIST
Credential:
Phone: 646-596-1858