Healthcare Provider Details

I. General information

NPI: 1073708475
Provider Name (Legal Business Name): JING MIAO ACUPUNCTURIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2007
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 W 102ND ST
NEW YORK NY
10025-4465
US

IV. Provider business mailing address

216 W 102ND ST
NEW YORK NY
10025-4465
US

V. Phone/Fax

Practice location:
  • Phone: 929-391-1213
  • Fax:
Mailing address:
  • Phone: 929-391-1213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number003485
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: