Healthcare Provider Details

I. General information

NPI: 1306372677
Provider Name (Legal Business Name): SERENDIPITOUS ACUPUNCTURE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2017
Last Update Date: 05/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 W 44TH ST FL 10
NEW YORK NY
10036-6611
US

IV. Provider business mailing address

15 W 44TH ST FL 10
NEW YORK NY
10036-6611
US

V. Phone/Fax

Practice location:
  • Phone: 212-575-8910
  • Fax: 212-575-1830
Mailing address:
  • Phone: 212-575-8910
  • Fax: 212-575-1830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number001738
License Number StateNY

VIII. Authorized Official

Name: MR. YU KANEKO
Title or Position: SOLE MEMBER
Credential: LAC
Phone: 212-575-8910