MEDICARE: LIC SKYLINE 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	:	1740969799
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIC SKYLINE ACUPUNCTURE PC

Provider Business Mailing Address
First Line	:	155 PROSPECT AVE STE 205
Second Line	:
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-4204
Country	:	US
Telephone Number	:	973-910-8288
Fax Number	:

Provider Business Practice Location Address
First Line	:	2315 44TH DR OFC
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-8900
Country	:	US
Telephone Number	:	973-910-8288
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	YANZHU LIU
Credential	:
Telephone Number	:	973-910-8288

Provider Enumeration Date	:	07/17/2023
Last Update Date	:	07/17/2023

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