Provider Demographics
NPI:1356677645
Name:WU, TERESA YEE WA (LAC, DIPL OM)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:YEE WA
Last Name:WU
Suffix:
Gender:F
Credentials:LAC, DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 WINTHROP DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-1318
Mailing Address - Country:US
Mailing Address - Phone:516-606-3856
Mailing Address - Fax:516-367-7306
Practice Address - Street 1:9 WINTHROP DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-1318
Practice Address - Country:US
Practice Address - Phone:516-606-3856
Practice Address - Fax:516-367-7306
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004109171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist