=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730311002
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANCIENT PATH CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2009
-----------------------------------------------------
Last Update Date | 08/19/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 394 LOWELL ST SUITE 16
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02420-2550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-863-0066
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 394 LOWELL ST SUITE 16
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02420-2550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-863-0066
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | YI-JEN TSENG
-----------------------------------------------------
Credential | LIC. AC.
-----------------------------------------------------
Telephone | 781-863-0066
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------