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General NPI Number Information
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NPI Number | 1700373842
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Entity Type | Organization
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Legal Business Name | GREENWICH ACUPUNCTURE CLINIC, LLC
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Dates
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Enumeration Date | 04/14/2018
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Last Update Date | 04/14/2018
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Provider Practice Location Address
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Address Line | 132 E PUTNAM AVE # 2C
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City | COS COB
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State | CT
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Zip | 06807-2744
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Country | US
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Telephone | 203-441-1228
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Fax |
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Provider Business Mailing Address
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Address Line | 132 E PUTNAM AVE STE 28
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City | COS COB
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State | CT
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Zip | 06807-2724
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Country | US
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Telephone | 203-441-1228
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Fax |
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Authorized Official
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Title or Position | OWNER/ACUPUNCTURIST
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Name | VICTORIA RYAN
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Credential | L.AC.
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Telephone | 203-441-1228
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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 | 000377
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License Number State | CT
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