Provider Demographics
NPI:1790287001
Name:SUNDANCE TRADITIONAL CHINESE MEDICINE
Entity Type:Organization
Organization Name:SUNDANCE TRADITIONAL CHINESE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LARKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DACM, LAC
Authorized Official - Phone:646-269-2615
Mailing Address - Street 1:5 TUDOR CITY PL APT 2031
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-9350
Mailing Address - Country:US
Mailing Address - Phone:646-752-5421
Mailing Address - Fax:
Practice Address - Street 1:291 BROADWAY RM 806
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-1912
Practice Address - Country:US
Practice Address - Phone:646-269-2615
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-02
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002285171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty