Provider Demographics
NPI:1669178257
Name:EAST BILLOW ACUPUNCTURE, P.C.
Entity type:Organization
Organization Name:EAST BILLOW ACUPUNCTURE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:SOUNGKYUM
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-364-1066
Mailing Address - Street 1:207 HALLOCK ROAD
Mailing Address - Street 2:STE 209
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-3082
Mailing Address - Country:US
Mailing Address - Phone:631-338-8516
Mailing Address - Fax:518-984-3120
Practice Address - Street 1:207 HALLOCK ROAD
Practice Address - Street 2:STE 209
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-3082
Practice Address - Country:US
Practice Address - Phone:631-338-8516
Practice Address - Fax:518-984-3120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-06
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty