Provider Demographics
NPI:1821411950
Name:GRAND CENTRAL ACUPUNCTURE WELLNESS PC
Entity Type:Organization
Organization Name:GRAND CENTRAL ACUPUNCTURE WELLNESS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUNG
Authorized Official - Middle Name:M
Authorized Official - Last Name:JUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-983-5100
Mailing Address - Street 1:140 E 52ND ST
Mailing Address - Street 2:2E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-6019
Mailing Address - Country:US
Mailing Address - Phone:212-983-5100
Mailing Address - Fax:
Practice Address - Street 1:140 E 52ND ST
Practice Address - Street 2:2E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-6019
Practice Address - Country:US
Practice Address - Phone:212-983-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-24
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003729171100000X, 171100000X
NY004696171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty