Provider Demographics
NPI:1851732770
Name:EL EVERGREEN ACU LLC
Entity Type:Organization
Organization Name:EL EVERGREEN ACU LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:212-971-0044
Mailing Address - Street 1:38 W 32ND ST
Mailing Address - Street 2:#501
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-3816
Mailing Address - Country:US
Mailing Address - Phone:212-971-0044
Mailing Address - Fax:212-760-0895
Practice Address - Street 1:38 W 32ND ST
Practice Address - Street 2:#501
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3816
Practice Address - Country:US
Practice Address - Phone:212-971-0044
Practice Address - Fax:212-760-0895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002925-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty