Provider Demographics
NPI:1780186734
Name:SACRED SILENCE ACUPUNTURE PLLC
Entity Type:Organization
Organization Name:SACRED SILENCE ACUPUNTURE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:KEENAN
Authorized Official - Last Name:GROW
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, MSTOM
Authorized Official - Phone:862-222-2571
Mailing Address - Street 1:620 WILSON AVE
Mailing Address - Street 2:PMB 222
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:440 WILSON AVE STE 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-5230
Practice Address - Country:US
Practice Address - Phone:862-222-2571
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty