Provider Demographics
NPI:1417280124
Name:RICHON INTEGRATED HEALTH SERVICES-PT&ACUPUNCTURE,PLLC.
Entity Type:Organization
Organization Name:RICHON INTEGRATED HEALTH SERVICES-PT&ACUPUNCTURE,PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JING
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:718-357-3638
Mailing Address - Street 1:2415 BELL BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-2222
Mailing Address - Country:US
Mailing Address - Phone:718-357-3638
Mailing Address - Fax:718-357-3638
Practice Address - Street 1:2415 BELL BLVD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-2222
Practice Address - Country:US
Practice Address - Phone:718-357-3638
Practice Address - Fax:718-357-3638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-13
Last Update Date:2009-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018320261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy