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General NPI Number Information
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NPI Number | 1366214900
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Entity Type | Organization
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Legal Business Name | FAN'S ACUPUNCTURE P.C.
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Dates
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Enumeration Date | 10/26/2023
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Last Update Date | 10/26/2023
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Provider Practice Location Address
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Address Line | 54 RADNOR RD
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City | GREAT NECK
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State | NY
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Zip | 11023-1429
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Country | US
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Telephone | 917-803-5808
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Fax |
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Provider Business Mailing Address
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Address Line | 54 RADNOR RD
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City | GREAT NECK
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State | NY
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Zip | 11023-1429
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | L.AC
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Name | XIN FAN
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Credential |
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Telephone | 917-803-5808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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