Provider Demographics
NPI:1215759139
Name:VITAL QI ACUPUNCTURE
Entity type:Organization
Organization Name:VITAL QI ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAC
Authorized Official - Prefix:
Authorized Official - First Name:JIAYU
Authorized Official - Middle Name:
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-669-5309
Mailing Address - Street 1:22511 59TH AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11364-2312
Mailing Address - Country:US
Mailing Address - Phone:917-669-5309
Mailing Address - Fax:
Practice Address - Street 1:248 LARKFIELD RD STE C
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-2443
Practice Address - Country:US
Practice Address - Phone:917-669-5309
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty