Provider Demographics
NPI:1437637899
Name:HEO, TAE SEOK
Entity Type:Individual
Prefix:
First Name:TAE
Middle Name:SEOK
Last Name:HEO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4133 LEXINGTON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-8311
Mailing Address - Country:US
Mailing Address - Phone:781-386-7250
Mailing Address - Fax:
Practice Address - Street 1:16 W 32ND ST STE 1105
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-1167
Practice Address - Country:US
Practice Address - Phone:917-580-0046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-29
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006330171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist