Provider Demographics
NPI:1891294898
Name:AN ZHUO YA ACUPUNCTURE
Entity Type:Organization
Organization Name:AN ZHUO YA ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOM
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LAC
Authorized Official - Phone:631-848-3772
Mailing Address - Street 1:876 SUNRISE HWY STE 20
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-5908
Mailing Address - Country:US
Mailing Address - Phone:631-848-3772
Mailing Address - Fax:634-532-1566
Practice Address - Street 1:876 SUNRISE HWY STE 20
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-5908
Practice Address - Country:US
Practice Address - Phone:631-848-3772
Practice Address - Fax:634-532-1566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-05
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5104-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty