MEDICARE: MRS. DANIELLE RACHEL KASSIN LAP, DOM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AP2904	FL

General Provider Information

NPI Number	:	1073876918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DANIELLE RACHEL KASSIN LAP, DOM

Provider Business Mailing Address
First Line	:	9801 COLLINS AVE APT 14I
Second Line	:
City	:	BAL HARBOUR
State	:	FL
Zip	:	33154-1840
Country	:	US
Telephone Number	:	305-606-8901
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 E HALLANDALE BEACH BLVD
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-4432
Country	:	US
Telephone Number	:	954-456-6945
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2012
Last Update Date	:	06/15/2012

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