Provider Demographics
NPI:1548751209
Name:ANDREW WU ACUPUNCTURE,P.C.
Entity Type:Organization
Organization Name:ANDREW WU ACUPUNCTURE,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSE ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:Y
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:631-249-2481
Mailing Address - Street 1:535 BROADHOLLOW RD STE M102
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-3719
Mailing Address - Country:US
Mailing Address - Phone:631-249-2481
Mailing Address - Fax:631-249-2483
Practice Address - Street 1:535 BROADHOLLOW RD STE M102
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3719
Practice Address - Country:US
Practice Address - Phone:631-249-2481
Practice Address - Fax:631-249-2483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001482261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY001482OtherNEW YORK STATE ACUPUNCTURE LICENSE