Provider Demographics
NPI:1730311002
Name:ANCIENT PATH CORPORATION
Entity Type:Organization
Organization Name:ANCIENT PATH CORPORATION
Other - Org Name:ANCIENT PATH ACUPUNCTURE AND HERBS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:YI-JEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TSENG
Authorized Official - Suffix:
Authorized Official - Credentials:LIC AC
Authorized Official - Phone:781-863-0066
Mailing Address - Street 1:394 LOWELL ST
Mailing Address - Street 2:SUITE 16
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-2550
Mailing Address - Country:US
Mailing Address - Phone:781-863-0066
Mailing Address - Fax:
Practice Address - Street 1:394 LOWELL ST
Practice Address - Street 2:SUITE 16
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-2550
Practice Address - Country:US
Practice Address - Phone:781-863-0066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-19
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center