MEDICARE: JESSICA HAWK 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	25 004835	NY

General Provider Information

NPI Number	:	1497099139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA HAWK L.AC.

Provider Business Mailing Address
First Line	:	PO BOX 179
Second Line	:
City	:	AURORA
State	:	NY
Zip	:	13026-0179
Country	:	US
Telephone Number	:	315-730-1153
Fax Number	:

Provider Business Practice Location Address
First Line	:	371 MAIN ST.
Second Line	:	2ND FLOOR
City	:	AURORA
State	:	NY
Zip	:	13026
Country	:	US
Telephone Number	:	315-710-1153
Fax Number	:

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

Provider Enumeration Date	:	11/19/2012
Last Update Date	:	11/19/2012

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