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General NPI Number Information
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NPI Number | 1366811481
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Entity Type | Organization
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Legal Business Name | HAUPPAUGE ACUPUNCTURE WELLNESS PC
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Dates
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Enumeration Date | 09/18/2015
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Last Update Date | 09/18/2015
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Provider Practice Location Address
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Address Line | 750 VETERANS HWY STE 103
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City | HAUPPAUGE
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State | NY
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Zip | 11788-2943
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Country | US
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Telephone | 201-937-1551
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Fax | 646-478-9778
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Provider Business Mailing Address
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Address Line | 750 VETERANS HWY STE 103
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City | HAUPPAUGE
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State | NY
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Zip | 11788-2943
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Country | US
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Telephone | 201-937-1551
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Fax | 646-478-9778
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Authorized Official
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Title or Position | LAC
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Name | SUNGMUN JUNG
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Credential |
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Telephone | 201-937-1551
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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 | 005148
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License Number State | NY
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