Provider Demographics
NPI:1992130546
Name:LOTUS WELLNESS INC
Entity type:Organization
Organization Name:LOTUS WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUZIE
Authorized Official - Middle Name:EYUNSOOK
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MAC, LAC
Authorized Official - Phone:917-532-2292
Mailing Address - Street 1:1229 SWAMP RD
Mailing Address - Street 2:
Mailing Address - City:FURLONG
Mailing Address - State:PA
Mailing Address - Zip Code:18925-1447
Mailing Address - Country:US
Mailing Address - Phone:917-532-2292
Mailing Address - Fax:
Practice Address - Street 1:1229 SWAMP RD
Practice Address - Street 2:
Practice Address - City:FURLONG
Practice Address - State:PA
Practice Address - Zip Code:18925-1447
Practice Address - Country:US
Practice Address - Phone:917-532-2292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-13
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KO000655171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1548694581OtherCMS