Healthcare Provider Details

I. General information

NPI: 1720898760
Provider Name (Legal Business Name): QING YI JOYCE HUANG LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2025
Last Update Date: 01/11/2025
Certification Date: 01/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 E BROADWAY STE 501
NEW YORK NY
10002-6994
US

IV. Provider business mailing address

91 E BROADWAY
STATEN ISLAND NY
10306-2028
US

V. Phone/Fax

Practice location:
  • Phone: 212-406-2439
  • Fax: 212-962-6633
Mailing address:
  • Phone: 917-882-1886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number007662
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: