Provider Demographics
NPI:1659553600
Name:PANG, ETIENNE SK (MS,LAC)
Entity Type:Individual
Prefix:MR
First Name:ETIENNE
Middle Name:SK
Last Name:PANG
Suffix:
Gender:M
Credentials:MS,LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 GREENE ST
Mailing Address - Street 2:2ND FL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-2663
Mailing Address - Country:US
Mailing Address - Phone:917-617-8481
Mailing Address - Fax:
Practice Address - Street 1:50 GREENE ST
Practice Address - Street 2:2ND FL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-2663
Practice Address - Country:US
Practice Address - Phone:917-617-8481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-02
Last Update Date:2007-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003058171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist