MEDICARE: JENNIFER MATHIS 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	007401	NY

General Provider Information

NPI Number	:	1528840121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MATHIS L.AC.

Provider Business Mailing Address
First Line	:	147 MIDDLESEX RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14610-1150
Country	:	US
Telephone Number	:	585-233-5289
Fax Number	:

Provider Business Practice Location Address
First Line	:	2139 N UNION ST STE 7A
Second Line	:
City	:	SPENCERPORT
State	:	NY
Zip	:	14559-1261
Country	:	US
Telephone Number	:	585-746-2187
Fax Number	:

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

Provider Enumeration Date	:	10/18/2023
Last Update Date	:	10/18/2023

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