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General NPI Number Information
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NPI Number | 1992188296
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Entity Type | Organization
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Legal Business Name | BLOOMING HEALTH ACUPUNCTURE P.C
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Dates
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Enumeration Date | 07/04/2015
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Last Update Date | 07/04/2015
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Provider Practice Location Address
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Address Line | 8415 4TH AVE
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City | BROOKLYN
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State | NY
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Zip | 11209-4654
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Country | US
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Telephone | 917-518-9050
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Fax |
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Provider Business Mailing Address
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Address Line | 558 DONGAN HILLS AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10305-3337
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Country | US
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Telephone | 917-518-9050
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | YULIYA LAGOS
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Credential | L.AC
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Telephone | 917-518-9050
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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 | 002823
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License Number State | NY
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