Provider Demographics
NPI:1073105813
Name:FLY AGAIN ACUPUNCTURE PLLC
Entity Type:Organization
Organization Name:FLY AGAIN ACUPUNCTURE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:ALYCIA
Authorized Official - Middle Name:V
Authorized Official - Last Name:ASKEW
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:518-232-1759
Mailing Address - Street 1:70 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:NY
Mailing Address - Zip Code:12834-1211
Mailing Address - Country:US
Mailing Address - Phone:518-232-1759
Mailing Address - Fax:518-633-1794
Practice Address - Street 1:70 MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:NY
Practice Address - Zip Code:12834-1211
Practice Address - Country:US
Practice Address - Phone:518-232-1759
Practice Address - Fax:518-633-1794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1063011955Medicaid
NY1710368634Medicaid