Provider Demographics
NPI:1346719465
Name:NEW YORK FOUR SEASONS ACUPUNCTURE PC
Entity Type:Organization
Organization Name:NEW YORK FOUR SEASONS ACUPUNCTURE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:SERENE
Authorized Official - Middle Name:
Authorized Official - Last Name:FENG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-651-6338
Mailing Address - Street 1:9217 71ST AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6706
Mailing Address - Country:US
Mailing Address - Phone:347-589-5723
Mailing Address - Fax:347-766-0933
Practice Address - Street 1:9217 71ST AVE STE 1
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-6706
Practice Address - Country:US
Practice Address - Phone:347-589-5723
Practice Address - Fax:347-766-0933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY005649OtherLICENSE