Provider Demographics
NPI:1790925162
Name:YUAN, STANLEY (LAC)
Entity Type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:
Last Name:YUAN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 WAUKENA AVE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-4738
Mailing Address - Country:US
Mailing Address - Phone:516-378-4325
Mailing Address - Fax:516-378-4326
Practice Address - Street 1:860 ATLANTIC AVE STE 4
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-4063
Practice Address - Country:US
Practice Address - Phone:516-378-4325
Practice Address - Fax:516-378-4326
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-25
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 1607171100000X
NY001689171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAP 1607OtherSTATE OF FLORIDA DEPT OF HEALTH LICENSE
NY001689OtherNEW YORK STATE EDUCATION DEPT - OFFICE OF PROFESSIONS