MEDICARE: 100 STREET ACUPUNCTURE PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	003641	NY

General Provider Information

NPI Number	:	1053857516
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	100 STREET ACUPUNCTURE PC

Provider Business Mailing Address
First Line	:	4207 ATLANTIC AVE
Second Line	:	SUITE 1A
City	:	BROOKLYN
State	:	NY
Zip	:	11224-1023
Country	:	US
Telephone Number	:	347-325-1515
Fax Number	:

Provider Business Practice Location Address
First Line	:	277 88TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-5609
Country	:	US
Telephone Number	:	347-325-1515
Fax Number	:

Authorized Official
Title or Position	:	ACUPUNCTURIST
Name	:	JULIA ALIKINA
Credential	:	L.AC
Telephone Number	:	347-325-1515

Provider Enumeration Date	:	01/09/2017
Last Update Date	:	01/09/2017

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