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General NPI Number Information
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NPI Number | 1417485384
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Entity Type | Organization
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Legal Business Name | ITHACA ACUPUNCTURE PALACE
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Dates
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Enumeration Date | 05/23/2017
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Last Update Date | 05/23/2017
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Provider Practice Location Address
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Address Line | 1274 DRYDEN RD
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City | ITHACA
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State | NY
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Zip | 14850-8795
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Country | US
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Telephone | 607-793-6355
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Fax |
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Provider Business Mailing Address
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Address Line | 207 CHRISTOPHER LN
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City | ITHACA
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State | NY
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Zip | 14850-1714
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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 | PRESIDENT
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Name | WAYNE CHEN
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Credential | ACU.
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Telephone | 607-796-3655
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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 | 003358
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License Number State | NY
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