Provider Demographics
NPI:1356649925
Name:STONYBROOK ACUPUNCTURE PC
Entity Type:Organization
Organization Name:STONYBROOK ACUPUNCTURE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BIN
Authorized Official - Middle Name:
Authorized Official - Last Name:XU
Authorized Official - Suffix:
Authorized Official - Credentials:PH D,LAC,MD,
Authorized Official - Phone:631-738-9368
Mailing Address - Street 1:5 ETHAN ALLEN CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11720-4608
Mailing Address - Country:US
Mailing Address - Phone:631-738-9368
Mailing Address - Fax:
Practice Address - Street 1:5 ETHAN ALLEN CT
Practice Address - Street 2:
Practice Address - City:SOUTH SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11720-4608
Practice Address - Country:US
Practice Address - Phone:631-738-9368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-07
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001135171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty