Provider Demographics
NPI:1174255681
Name:ANCIENT ACUPUNCTURE AND CHINESE HERBS
Entity Type:Organization
Organization Name:ANCIENT ACUPUNCTURE AND CHINESE HERBS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCFTURIST
Authorized Official - Prefix:
Authorized Official - First Name:JIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FANG
Authorized Official - Suffix:
Authorized Official - Credentials:NYS LAC
Authorized Official - Phone:585-223-7880
Mailing Address - Street 1:6605 PITTSFORD PALMYRA RD OFC PARKE-2
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-3407
Mailing Address - Country:US
Mailing Address - Phone:585-223-7880
Mailing Address - Fax:
Practice Address - Street 1:6605 PITTSFORD PALMYRA RD OFC PARKE-2
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-3407
Practice Address - Country:US
Practice Address - Phone:585-223-7880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty