Provider Demographics
NPI:1770098162
Name:DRAGONFLY ACUPUNCTURE, PLLC
Entity type:Organization
Organization Name:DRAGONFLY ACUPUNCTURE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAI
Authorized Official - Middle Name:K
Authorized Official - Last Name:ASSALONE
Authorized Official - Suffix:
Authorized Official - Credentials:DACM, LAC
Authorized Official - Phone:718-640-5184
Mailing Address - Street 1:17007 LITHONIA AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11365-1105
Mailing Address - Country:US
Mailing Address - Phone:718-640-5184
Mailing Address - Fax:
Practice Address - Street 1:16020 WILLETS POINT BLVD
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-3342
Practice Address - Country:US
Practice Address - Phone:718-279-4300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-06
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006090171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty