Healthcare Provider Details

I. General information

NPI: 1083815138
Provider Name (Legal Business Name): WREN ACUPUNCTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 WALL ST STE 500
NEW YORK NY
10005-2201
US

IV. Provider business mailing address

30 WALL ST STE 500
NEW YORK NY
10005-2201
US

V. Phone/Fax

Practice location:
  • Phone: 212-742-8000
  • Fax: 212-742-1557
Mailing address:
  • Phone: 212-742-8000
  • Fax: 212-742-1557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number001675
License Number StateNY

VIII. Authorized Official

Name: QI FANG REN
Title or Position: OWNER
Credential: LAC
Phone: 212-742-8000