Individual
JACK MA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ACUPUNCTURIST
Contact information
Practice address
53 WOODBURY RD, HICKSVILLE, NY 11801-3041
(646) 479-7689
Mailing address
20644 45TH RD, BAYSIDE, NY 11361-3121
(646) 479-7689
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
005627
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25MZ001172000
ACUPUNCTURE
NJ
01
—
5627
ACCUPUNCTURE
NY
Enumeration date
09/15/2015
Last updated
04/17/2019
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