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General NPI Number Information
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NPI Number | 1568719078
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Entity Type | Organization
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Legal Business Name | SUFEN GONG ACUPUNCTURE CLINIC
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Dates
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Enumeration Date | 08/14/2012
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Last Update Date | 08/14/2012
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Provider Practice Location Address
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Address Line | 4513 OLD VESTAL RD
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City | VESTAL
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State | NY
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Zip | 13850-3571
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Country | US
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Telephone | 607-621-3126
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Fax | 607-729-6434
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Provider Business Mailing Address
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Address Line | 4513 OLD VESTAL RD
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City | VESTAL
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State | NY
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Zip | 13850-3571
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Country | US
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Telephone | 607-621-3126
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Fax | 607-729-6434
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Authorized Official
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Title or Position | L.AC
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Name | SUFEN GONG
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Credential | ACUPUNCTURIST
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Telephone | 607-621-3126
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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 | 3061
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License Number State | NY
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