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General NPI Number Information
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NPI Number | 1447750815
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Entity Type | Individual
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Provider Name | ESTHER SU SHIN LAC , ACUPUNCTURE
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Gender | Female
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Dates
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Enumeration Date | 02/13/2018
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Last Update Date | 04/27/2023
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Provider Practice Location Address
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Address Line | 7925 WINCHESTER BLVD
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City | QUEENS VILLAGE
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State | NY
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Zip | 11427-2128
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Country | US
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Telephone | 718-264-4050
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 770282
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City | WOODSIDE
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State | NY
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Zip | 11377-0282
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Country | US
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Telephone | 929-395-5998
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 166037
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License Number State | NY
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Taxonomy #2
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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 | NY
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Taxonomy #3
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Taxonomy Code | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number | 568117
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License Number State | NY
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