=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679884415
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YAJIE WANG L.AC.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2010
-----------------------------------------------------
Last Update Date | 04/28/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 315 MADISON AVE RM 2305
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10017-5413
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-409-6543
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7002 KENNEDY BLVD E #28I
-----------------------------------------------------
City | WEST NEW YORK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07093-4929
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-922-2223
-----------------------------------------------------
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 | 003708
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------