MEDICARE: MS. ELYSE IRIS JOSEPHS 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	002232	NY
2	171100000X	Acupuncturist	000383	CT

General Provider Information

NPI Number	:	1396868287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELYSE IRIS JOSEPHS L.AC.

Provider Business Mailing Address
First Line	:	PO BOX 20762
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10021-0075
Country	:	US
Telephone Number	:	917-374-6046
Fax Number	:	212-734-9240

Provider Business Practice Location Address
First Line	:	34 W 12TH ST
Second Line	:	TWELTH MERIDIAN
City	:	NEW YORK
State	:	NY
Zip	:	10011-8636
Country	:	US
Telephone Number	:	917-374-6046
Fax Number	:	212-734-9240

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

Provider Enumeration Date	:	04/08/2007
Last Update Date	:	07/08/2007

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