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General NPI Number Information
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NPI Number | 1013588441
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Entity Type | Organization
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Legal Business Name | THE PATHWAY ACUPUNCTURE, P.C.
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Dates
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Enumeration Date | 07/07/2021
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Last Update Date | 07/07/2021
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Provider Practice Location Address
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Address Line | 214-06 18TH AVE
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City | BAYSIDE
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State | NY
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Zip | 11360
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Country | US
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Telephone | 718-819-8728
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Fax |
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Provider Business Mailing Address
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Address Line | 214-06 18TH AVE
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City | BAYSIDE
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State | NY
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Zip | 11360
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Country | US
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Telephone | 718-819-8728
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | KEUN AE PARK
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Credential |
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Telephone | 718-819-8728
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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