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General NPI Number Information
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NPI Number | 1205289931
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Entity Type | Organization
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Legal Business Name | PROMISE HEALING ACUPUNCTURE, PLLC
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Dates
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Enumeration Date | 07/18/2016
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Last Update Date | 07/18/2016
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Provider Practice Location Address
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Address Line | 4109 108TH ST SUITE LL
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City | CORONA
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State | NY
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Zip | 11368-3477
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Country | US
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Telephone | 718-205-2230
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Fax | 718-205-2245
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Provider Business Mailing Address
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Address Line | 4109 108TH ST SUITE LL
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City | CORONA
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State | NY
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Zip | 11368-3477
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Country | US
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Telephone | 718-205-2230
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Fax | 718-205-2245
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. YOUNG S PARK
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Credential |
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Telephone | 718-205-2230
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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 | 002591
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License Number State | NY
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