Provider Demographics
NPI:1700373842
Name:GREENWICH ACUPUNCTURE CLINIC, LLC
Entity Type:Organization
Organization Name:GREENWICH ACUPUNCTURE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:203-441-1228
Mailing Address - Street 1:132 E PUTNAM AVE STE 28
Mailing Address - Street 2:
Mailing Address - City:COS COB
Mailing Address - State:CT
Mailing Address - Zip Code:06807-2724
Mailing Address - Country:US
Mailing Address - Phone:203-441-1228
Mailing Address - Fax:
Practice Address - Street 1:132 E PUTNAM AVE # 2C
Practice Address - Street 2:
Practice Address - City:COS COB
Practice Address - State:CT
Practice Address - Zip Code:06807-2744
Practice Address - Country:US
Practice Address - Phone:203-441-1228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-14
Last Update Date:2018-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000377171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty