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General NPI Number Information
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NPI Number | 1043631021
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Entity Type | Individual
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Provider Name | PAUL MINSEOK TAK
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Gender | Male
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Dates
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Enumeration Date | 12/18/2013
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Last Update Date | 11/09/2016
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Provider Practice Location Address
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Address Line | 8655 BROADWAY STE C4
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City | ELMHURST
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State | NY
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Zip | 11373-5868
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Country | US
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Telephone | 201-966-7828
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Fax |
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Provider Business Mailing Address
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Address Line | 230 LEXINGTON AVE
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City | DUMONT
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State | NJ
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Zip | 07628-1734
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Country | US
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Telephone | 201-966-7828
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 005178
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License Number State | NY
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