=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497951214
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TETYANA VASYLENKO L.AC.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2007
-----------------------------------------------------
Last Update Date | 08/11/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1330 PARKWAY AVE SUITE 9
-----------------------------------------------------
City | EWING
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08628-3006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-771-6192
-----------------------------------------------------
Fax | 609-771-6874
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2088 OLD WELSH RD
-----------------------------------------------------
City | ABINGTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-658-4917
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 25MZ00048800
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AK000819
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------