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General NPI Number Information
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NPI Number | 1417840711
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Entity Type | Organization
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Legal Business Name | NORTHPORT ACUPUNCTURE PC
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Dates
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Enumeration Date | 06/03/2025
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 2500 NESCONSET HWY BLDG 24C
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City | STONY BROOK
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State | NY
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Zip | 11790-2598
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Country | US
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Telephone | 631-703-1192
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Fax |
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Provider Business Mailing Address
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Address Line | 2500 NESCONSET HWY BLDG 24C
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City | STONY BROOK
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State | NY
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Zip | 11790-2598
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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 | JUAN LIN
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Credential |
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Telephone | 631-703-1192
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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 |
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License Number State |
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