MEDICARE: VISTA ACUPUNCTURE P.C.

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	004302	NY
2	171100000X	Acupuncturist	001607	NY

General Provider Information

NPI Number	:	1790023299
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISTA ACUPUNCTURE P.C.

Provider Business Mailing Address
First Line	:	573 MCDONALD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-3807
Country	:	US
Telephone Number	:	917-385-1567
Fax Number	:

Provider Business Practice Location Address
First Line	:	573 MCDONALD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-3807
Country	:	US
Telephone Number	:	917-385-1567
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ZHI YUAN ZHONG
Credential	:	ACUPUNCTURIST
Telephone Number	:	917-385-1567

Provider Enumeration Date	:	01/18/2013
Last Update Date	:	01/18/2013

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