=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396278263
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EASTERN LIGHT ACUPUNCTURE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/07/2017
-----------------------------------------------------
Last Update Date | 04/07/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 280 DOBBS FERRY RD SUITE 204
-----------------------------------------------------
City | WHITE PLAINS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10607-1900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-686-2353
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11 ROUNDTOP RD
-----------------------------------------------------
City | YONKERS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10710-2327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-686-2353
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED ACUPUNCTURIST
-----------------------------------------------------
Name | HUI LI
-----------------------------------------------------
Credential | L.AC.
-----------------------------------------------------
Telephone | 914-686-2353
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 000842
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------