Provider Demographics
NPI:1588222509
Name:STONY BROOK ACUPUNCTURE AND MASSAGE THERAPY PC
Entity Type:Organization
Organization Name:STONY BROOK ACUPUNCTURE AND MASSAGE THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JONGKOO
Authorized Official - Middle Name:
Authorized Official - Last Name:AHN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, MT
Authorized Official - Phone:917-563-1824
Mailing Address - Street 1:215 HALLOCK RD STE 6A
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-3077
Mailing Address - Country:US
Mailing Address - Phone:917-563-1824
Mailing Address - Fax:929-900-1843
Practice Address - Street 1:215 HALLOCK RD STE 6A
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-3077
Practice Address - Country:US
Practice Address - Phone:917-563-1824
Practice Address - Fax:929-900-1843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty