Provider Demographics
NPI:1720605918
Name:LOVE PEACE ACUPUNCTURE PC
Entity Type:Organization
Organization Name:LOVE PEACE ACUPUNCTURE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOON
Authorized Official - Suffix:
Authorized Official - Credentials:L AC
Authorized Official - Phone:917-530-0268
Mailing Address - Street 1:203 GENUNG ST APT 717
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-2561
Mailing Address - Country:US
Mailing Address - Phone:917-530-0268
Mailing Address - Fax:
Practice Address - Street 1:400 ROUTE 211 E STE 12
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-2123
Practice Address - Country:US
Practice Address - Phone:917-530-0268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-03
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty