Provider Demographics
NPI:1023332780
Name:GREEN LEAF ACUPUNCTURE PC
Entity type:Organization
Organization Name:GREEN LEAF ACUPUNCTURE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:L AC
Authorized Official - Phone:516-225-0730
Mailing Address - Street 1:1635 BELL BLVD
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1639
Mailing Address - Country:US
Mailing Address - Phone:917-535-7455
Mailing Address - Fax:
Practice Address - Street 1:18311 HILLSIDE AVE
Practice Address - Street 2:SUITE DD
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4840
Practice Address - Country:US
Practice Address - Phone:718-297-0909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002683171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty