=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700091758
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED ACUPUNCTURE HEALTH, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2007
-----------------------------------------------------
Last Update Date | 02/28/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 LIVINGSTON ST STE 2 PARK AVE. TRAUMA
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11201-5023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-374-6046
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 20762
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10021-0075
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-374-6046
-----------------------------------------------------
Fax | 212-734-9240
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. ELYSE IRIS JOSEPHS
-----------------------------------------------------
Credential | L.AC.
-----------------------------------------------------
Telephone | 917-374-6046
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 002232
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------