Provider Demographics
NPI:1710375738
Name:ANCIENT & MODERN ACUPUNCTURE P.C.
Entity type:Organization
Organization Name:ANCIENT & MODERN ACUPUNCTURE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:MR
Authorized Official - First Name:YEVGENIY
Authorized Official - Middle Name:
Authorized Official - Last Name:VOLOSHCHUK
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:917-658-0152
Mailing Address - Street 1:2800 COYLE ST
Mailing Address - Street 2:APT.321
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-1747
Mailing Address - Country:US
Mailing Address - Phone:917-658-0152
Mailing Address - Fax:
Practice Address - Street 1:1534 BROADWAY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-4249
Practice Address - Country:US
Practice Address - Phone:718-576-6266
Practice Address - Fax:718-576-6269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-29
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002065302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization