Provider Demographics
NPI:1164788840
Name:ACUPUNCTURE AND ORIENTAL MEDICINE CENTER, LLC
Entity Type:Organization
Organization Name:ACUPUNCTURE AND ORIENTAL MEDICINE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CYRUS
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:267-342-5880
Mailing Address - Street 1:P.O. BOX 341
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-9998
Mailing Address - Country:US
Mailing Address - Phone:267-342-5880
Mailing Address - Fax:
Practice Address - Street 1:2014 FAIRMOUNT AVENUE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-2602
Practice Address - Country:US
Practice Address - Phone:267-342-5880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-06
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK000397261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service