Provider Demographics
NPI:1821381476
Name:EASTGATE ACUPUNCTURE P.C.
Entity Type:Organization
Organization Name:EASTGATE ACUPUNCTURE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:DMYTRYK
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:914-713-1000
Mailing Address - Street 1:177 E HARTSDALE AVE
Mailing Address - Street 2:SUITE LLA
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-3543
Mailing Address - Country:US
Mailing Address - Phone:914-713-1000
Mailing Address - Fax:914-713-1020
Practice Address - Street 1:177 E HARTSDALE AVE
Practice Address - Street 2:SUITE LLA
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-3543
Practice Address - Country:US
Practice Address - Phone:914-713-1000
Practice Address - Fax:914-713-1020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004451171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty