Provider Demographics
NPI:1912371972
Name:HOANG-SIMKO, JENNIFER-THANH (LAC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER-THANH
Middle Name:
Last Name:HOANG-SIMKO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:HOANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:640 BELLE TERRE ROAD, D
Mailing Address - Street 2:SUITE2
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777
Mailing Address - Country:US
Mailing Address - Phone:631-403-3254
Mailing Address - Fax:631-229-9318
Practice Address - Street 1:640 BELLE TERRE RD STE D2
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-1936
Practice Address - Country:US
Practice Address - Phone:631-880-2180
Practice Address - Fax:631-229-9318
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-13
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1033171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist