Healthcare Provider Details

I. General information

NPI: 1851732770
Provider Name (Legal Business Name): EL EVERGREEN ACU LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2013
Last Update Date: 07/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 W 32ND ST #501
NEW YORK NY
10001-3816
US

IV. Provider business mailing address

38 W 32ND ST #501
NEW YORK NY
10001-3816
US

V. Phone/Fax

Practice location:
  • Phone: 212-971-0044
  • Fax: 212-760-0895
Mailing address:
  • Phone: 212-971-0044
  • Fax: 212-760-0895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number002925-1
License Number StateNY

VIII. Authorized Official

Name: DR. EUGENE LEE
Title or Position: PRESIDENT
Credential: LAC
Phone: 212-971-0044