Healthcare Provider Details

I. General information

NPI: 1447750815
Provider Name (Legal Business Name): ESTHER SU SHIN LAC , ACUPUNCTURE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2018
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7925 WINCHESTER BLVD
QUEENS VILLAGE NY
11427-2128
US

IV. Provider business mailing address

PO BOX 770282
WOODSIDE NY
11377-0282
US

V. Phone/Fax

Practice location:
  • Phone: 718-264-4050
  • Fax:
Mailing address:
  • Phone: 929-395-5998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number166037
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number568117
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: