Healthcare Provider Details

I. General information

NPI: 1336073030
Provider Name (Legal Business Name): EAST WELLNESS ACUPUNCTURE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 2ND AVE RM 805
NEW YORK NY
10017-9223
US

IV. Provider business mailing address

800 2ND AVE RM 805
NEW YORK NY
10017-9223
US

V. Phone/Fax

Practice location:
  • Phone: 212-581-1074
  • Fax:
Mailing address:
  • Phone: 917-261-6835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: AIFENG SONG
Title or Position: MANAGER
Credential:
Phone: 929-800-8428