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General NPI Number Information
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NPI Number | 1326515560
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Entity Type | Organization
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Legal Business Name | GARDENIA ACUPUNCTURE
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Dates
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Enumeration Date | 10/25/2018
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Last Update Date | 10/25/2018
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Provider Practice Location Address
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Address Line | 253 W END DRIVE
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City | LITTLE NECK
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State | NY
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Zip | 11362
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Country | US
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Telephone | 646-267-9332
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Fax |
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Provider Business Mailing Address
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Address Line | 25302 W END DR
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City | LITTLE NECK
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State | NY
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Zip | 11362-1443
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Country | US
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Telephone | 646-267-9332
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST/ OWNER
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Name | MIAE SON
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Credential |
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Telephone | 646-267-9332
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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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