Active NPI
Simone Wan, L.AC, M.S.T.O.M.
- Acupuncturist
- New York, NY
National Provider Identifier
1174748503
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- 002972
- Practice address
- 251 5TH Ave
3Rd Floor
New York, NY 10016-6515 - Phone
- (646) 221-5057
- NPI assigned
- Apr 13, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist | 171100000X | 002972 | NY | Primary |
Addresses
Primary practice location
251 5TH Ave
3Rd Floor
New York, NY 10016-6515
Mailing address
163 Edge Hill Rd
Fairfield, CT 06824-5213
Phone (646) 221-5057
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 002972 | NY | MD | Critical Care Medicine (Internal Medicine) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176422400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1174748503",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "163 EDGE HILL RD",
"city": "FAIRFIELD",
"state": "CT",
"postal_code": "068245213",
"telephone_number": "646-221-5057"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "251 5TH AVE",
"address_2": "3RD FLOOR",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100166515",
"telephone_number": "646-221-5057"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAN",
"first_name": "SIMONE",
"credential": "L.AC, M.S.T.O.M.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "NY",
"license": "002972",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.