=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548751209
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANDREW WU ACUPUNCTURE,P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2018
-----------------------------------------------------
Last Update Date | 05/29/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 535 BROADHOLLOW RD STE M102
-----------------------------------------------------
City | MELVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11747-3719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-249-2481
-----------------------------------------------------
Fax | 631-249-2483
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 535 BROADHOLLOW RD STE M102
-----------------------------------------------------
City | MELVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11747-3719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-249-2481
-----------------------------------------------------
Fax | 631-249-2483
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSE ACUPUNCTURIST
-----------------------------------------------------
Name | ANDREW Y WU
-----------------------------------------------------
Credential | L.AC.
-----------------------------------------------------
Telephone | 631-249-2481
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 001482
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------