=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871113407
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | QI TREE ACUPUNCTURE P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2020
-----------------------------------------------------
Last Update Date | 04/23/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1336 UTICA AVE FL 2
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11203-5912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-801-4858
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21 GRANITE ST APT 2R
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11207-1678
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-536-8260
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | PROF. JOMO ALAKOYE-SIMMONS
-----------------------------------------------------
Credential | L.AC.
-----------------------------------------------------
Telephone | 646-801-4858
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------