Provider Demographics
NPI:1558701573
Name:YWACUPUNCTURIST PC
Entity Type:Organization
Organization Name:YWACUPUNCTURIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YARONG
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-690-2008
Mailing Address - Street 1:2 PINE WEST PLAZA
Mailing Address - Street 2:WASHINGTON AVE EXT
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 PINE WEST PLZ
Practice Address - Street 2:WASHINGTON AVE EXT
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-5532
Practice Address - Country:US
Practice Address - Phone:518-690-2008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-05
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002400171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty