Provider Demographics
NPI:1164045423
Name:LOTUS GREEN ACUPUNCTURE P.C.
Entity Type:Organization
Organization Name:LOTUS GREEN ACUPUNCTURE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONGWHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-381-2688
Mailing Address - Street 1:156 DOLSON AVE STE 11
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-6560
Mailing Address - Country:US
Mailing Address - Phone:845-381-2688
Mailing Address - Fax:845-345-8201
Practice Address - Street 1:156 DOLSON AVE STE 11
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-6560
Practice Address - Country:US
Practice Address - Phone:845-381-2688
Practice Address - Fax:845-345-8201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-21
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty