Healthcare Provider Details

I. General information

NPI: 1629637863
Provider Name (Legal Business Name): FIFTH AVENUE ACUP HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 W 45TH ST STE 1702
NEW YORK NY
10036-4221
US

IV. Provider business mailing address

2 W 45TH ST STE 1702
NEW YORK NY
10036-4221
US

V. Phone/Fax

Practice location:
  • Phone: 646-861-2060
  • Fax: 646-861-2041
Mailing address:
  • Phone: 646-861-2060
  • Fax: 646-861-2041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MAN MARY NG
Title or Position: ACUPUNCTURIST
Credential: L.AC.
Phone: 646-861-2060