MEDICARE: MRS. HOLLY CLARK CRAFTS COLASANTI 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	004444	NY

General Provider Information

NPI Number	:	1457640732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HOLLY CLARK CRAFTS COLASANTI L.AC.

Provider Business Mailing Address
First Line	:	404 3RD ST
Second Line	:	#D1
City	:	BROOKLYN
State	:	NY
Zip	:	11215-2868
Country	:	US
Telephone Number	:	347-417-0919
Fax Number	:

Provider Business Practice Location Address
First Line	:	36 PLAZA ST E
Second Line	:	SUITE #1A
City	:	BROOKLYN
State	:	NY
Zip	:	11238-5048
Country	:	US
Telephone Number	:	347-417-0919
Fax Number	:

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

Provider Enumeration Date	:	04/07/2011
Last Update Date	:	05/31/2011

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