=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417280124
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RICHON INTEGRATED HEALTH SERVICES-PT&ACUPUNCTURE,PLLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2009
-----------------------------------------------------
Last Update Date | 09/13/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2415 BELL BLVD
-----------------------------------------------------
City | BAYSIDE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11360-2222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-357-3638
-----------------------------------------------------
Fax | 718-357-3638
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2415 BELL BLVD
-----------------------------------------------------
City | BAYSIDE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11360-2222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-357-3638
-----------------------------------------------------
Fax | 718-357-3638
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST
-----------------------------------------------------
Name | JING SHAN
-----------------------------------------------------
Credential | M.S.
-----------------------------------------------------
Telephone | 718-357-3638
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 018320
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------