MEDICARE: NINA A SEPE L.AC.

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	002478	NY

General Provider Information

NPI Number	:	1356989602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NINA A SEPE L.AC.

Provider Business Mailing Address
First Line	:	333 OVINGTON AVE APT A54
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-1445
Country	:	US
Telephone Number	:	718-748-9728
Fax Number	:

Provider Business Practice Location Address
First Line	:	108 KENILWORTH PL
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-2439
Country	:	US
Telephone Number	:	718-748-9728
Fax Number	:

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

Provider Enumeration Date	:	12/17/2019
Last Update Date	:	12/17/2019

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