Provider Demographics
NPI:1831666445
Name:WHITE PLAINS ACUPUNCTURE PLLC
Entity Type:Organization
Organization Name:WHITE PLAINS ACUPUNCTURE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GINNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:914-354-0333
Mailing Address - Street 1:180 S BROADWAY STE 300
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-1841
Mailing Address - Country:US
Mailing Address - Phone:914-354-0333
Mailing Address - Fax:
Practice Address - Street 1:180 S BROADWAY STE 300
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1841
Practice Address - Country:US
Practice Address - Phone:914-354-0333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1902181936Medicaid