Healthcare Provider Details

I. General information

NPI: 1164368460
Provider Name (Legal Business Name): VITAL LIGHT ACUPUNCTURE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 SHORE FRONT PKWY APT 7U
ROCKAWAY BEACH NY
11693-2117
US

IV. Provider business mailing address

8100 SHORE FRONT PKWY APT 7U
ROCKAWAY BEACH NY
11693-2117
US

V. Phone/Fax

Practice location:
  • Phone: 718-954-4940
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: IHAR TOSIN
Title or Position: PRESIDENT
Credential:
Phone: 732-416-4123