Provider Demographics
NPI:1205289931
Name:PROMISE HEALING ACUPUNCTURE, PLLC
Entity type:Organization
Organization Name:PROMISE HEALING ACUPUNCTURE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:YOUNG
Authorized Official - Middle Name:S
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-205-2230
Mailing Address - Street 1:4109 108TH ST
Mailing Address - Street 2:SUITE LL
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-3477
Mailing Address - Country:US
Mailing Address - Phone:718-205-2230
Mailing Address - Fax:718-205-2245
Practice Address - Street 1:4109 108TH ST
Practice Address - Street 2:SUITE LL
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-3477
Practice Address - Country:US
Practice Address - Phone:718-205-2230
Practice Address - Fax:718-205-2245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002591171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
08327GMedicare PIN