MEDICARE: GARY LUONG MAOM, L.AC.

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	006857	NY

General Provider Information

NPI Number	:	1245822717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY LUONG MAOM, L.AC.

Provider Business Mailing Address
First Line	:	1012 39TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-1021
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5901 16TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-2114
Country	:	US
Telephone Number	:	917-293-9296
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2021
Last Update Date	:	04/28/2021

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