Healthcare Provider Details

I. General information

NPI: 1134206840
Provider Name (Legal Business Name): BIN XU M.D, LAC,PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 10/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 ETHAN ALLEN CT
SOUTH SETAUKET NY
11720-4608
US

IV. Provider business mailing address

5 ETHAN ALLEN CT
SOUTH SETAUKET NY
11720-4608
US

V. Phone/Fax

Practice location:
  • Phone: 631-738-9368
  • Fax: 516-873-9622
Mailing address:
  • Phone: 631-738-9368
  • Fax: 516-873-9622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number001135
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: