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General NPI Number Information
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NPI Number | 1891294898
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Entity Type | Organization
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Legal Business Name | AN ZHUO YA ACUPUNCTURE
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Dates
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Enumeration Date | 02/05/2018
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Last Update Date | 09/28/2021
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Provider Practice Location Address
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Address Line | 876 SUNRISE HWY STE 20
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City | BAY SHORE
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State | NY
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Zip | 11706-5908
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Country | US
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Telephone | 631-848-3772
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Fax | 634-532-1566
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Provider Business Mailing Address
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Address Line | 876 SUNRISE HWY STE 20
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City | BAY SHORE
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State | NY
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Zip | 11706-5908
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Country | US
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Telephone | 631-848-3772
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Fax | 634-532-1566
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | ANDREA BLOM
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Credential | M.S., L.AC.
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Telephone | 631-848-3772
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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 | 5104-1
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License Number State | NY
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