Provider Demographics
NPI:1003371022
Name:SUPPLE MIND ACUPUNCTURE P.C.
Entity Type:Organization
Organization Name:SUPPLE MIND ACUPUNCTURE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MUN
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHIEH
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:917-362-2018
Mailing Address - Street 1:6914 183RD ST
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-3536
Mailing Address - Country:US
Mailing Address - Phone:917-362-2018
Mailing Address - Fax:917-463-1056
Practice Address - Street 1:4160 MAIN ST STE 209A
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3899
Practice Address - Country:US
Practice Address - Phone:917-933-8503
Practice Address - Fax:917-463-1056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-04
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty