Provider Demographics
NPI:1972017952
Name:ASSALONE, TAI K (DACM, LAC)
Entity Type:Individual
Prefix:
First Name:TAI
Middle Name:K
Last Name:ASSALONE
Suffix:
Gender:F
Credentials:DACM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17007 LITHONIA AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11365-1105
Mailing Address - Country:US
Mailing Address - Phone:718-640-5184
Mailing Address - Fax:
Practice Address - Street 1:16020 WILLETS POINT BLVD
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-3342
Practice Address - Country:US
Practice Address - Phone:718-279-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-29
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006090-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist