Provider Demographics
NPI:1417047523
Name:HE, JIAN (LAC)
Entity Type:Individual
Prefix:MR
First Name:JIAN
Middle Name:
Last Name:HE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:MR
Other - First Name:MICHAEL
Other - Middle Name:JIAN
Other - Last Name:HE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:25 DEER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD CORNERS
Mailing Address - State:NY
Mailing Address - Zip Code:10549-4200
Mailing Address - Country:US
Mailing Address - Phone:917-855-9711
Mailing Address - Fax:
Practice Address - Street 1:344 E MAIN ST
Practice Address - Street 2:SUITE 302
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3027
Practice Address - Country:US
Practice Address - Phone:914-666-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000848171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist