MEDICARE: GARDEN 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	3955	NY

General Provider Information

NPI Number	:	1992115786
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARDEN ACUPUNCTURE, PC

Provider Business Mailing Address
First Line	:	790A UNION ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-1307
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	790A UNION ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-1307
Country	:	US
Telephone Number	:	646-234-3643
Fax Number	:

Authorized Official
Title or Position	:	PRINCIPLE
Name	:	ALEX GOLDBERG
Credential	:	LAC
Telephone Number	:	646-234-3643

Provider Enumeration Date	:	05/01/2014
Last Update Date	:	05/01/2014

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