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General NPI Number Information
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NPI Number | 1912371972
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Entity Type | Individual
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Provider Name | JENNIFER-THANH HOANG-SIMKO L.AC
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Gender | Female
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Dates
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Enumeration Date | 11/13/2015
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Last Update Date | 04/14/2022
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Provider Practice Location Address
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Address Line | 640 BELLE TERRE RD STE D2
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-1936
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Country | US
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Telephone | 631-880-2180
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Fax | 631-229-9318
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Provider Business Mailing Address
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Address Line | 640 BELLE TERRE ROAD, D SUITE2
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City | PORT JEFFERSON
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State | NY
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Zip | 11777
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Country | US
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Telephone | 631-403-3254
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Fax | 631-229-9318
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 1033
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License Number State | NY
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