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General NPI Number Information
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NPI Number | 1366562209
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Entity Type | Individual
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Provider Name | LAN MA L.AC.
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Gender | Female
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Dates
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Enumeration Date | 03/31/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5403 QUEENS BLVD
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City | WOODSIDE
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State | NY
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Zip | 11377-4642
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Country | US
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Telephone | 718-779-2500
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Fax | 718-779-5522
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Provider Business Mailing Address
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Address Line | 21720 47TH AVE
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City | BAYSIDE
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State | NY
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Zip | 11361-3526
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Country | US
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Telephone | 646-331-1343
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Fax | 718-229-1002
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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 | 002080
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License Number State | NY
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