MEDICARE: NORTHPORT 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

General Provider Information

NPI Number	:	1417840711
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHPORT ACUPUNCTURE PC

Provider Business Mailing Address
First Line	:	2500 NESCONSET HWY BLDG 24C
Second Line	:
City	:	STONY BROOK
State	:	NY
Zip	:	11790-2598
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 NESCONSET HWY BLDG 24C
Second Line	:
City	:	STONY BROOK
State	:	NY
Zip	:	11790-2598
Country	:	US
Telephone Number	:	631-703-1192
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JUAN LIN
Credential	:
Telephone Number	:	631-703-1192

Provider Enumeration Date	:	06/03/2025
Last Update Date	:	06/03/2025

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