MEDICARE: MS. HONGTAO WANG LAC

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	001692	NY

General Provider Information

NPI Number	:	1871503334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HONGTAO WANG LAC

Provider Business Mailing Address
First Line	:	1590 UNION BLVD
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-7358
Country	:	US
Telephone Number	:	631-665-2421
Fax Number	:	631-665-3416

Provider Business Practice Location Address
First Line	:	1590 UNION BLVD
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-7358
Country	:	US
Telephone Number	:	631-665-2421
Fax Number	:	631-665-3416

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

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	07/08/2007

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