MEDICARE: MS. KIMBERLY ANN LOTOCKE 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	002947	NY

General Provider Information

NPI Number	:	1639469125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIMBERLY ANN LOTOCKE L.AC.

Provider Business Mailing Address
First Line	:	PO BOX 10059
Second Line	:
City	:	NEWBURGH
State	:	NY
Zip	:	12552-0059
Country	:	US
Telephone Number	:	845-527-0293
Fax Number	:

Provider Business Practice Location Address
First Line	:	8 COLONEL FOSTER DRIVE
Second Line	:
City	:	ROCK TAVERN
State	:	NY
Zip	:	12575
Country	:	US
Telephone Number	:	845-527-0293
Fax Number	:

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

Provider Enumeration Date	:	04/18/2011
Last Update Date	:	04/29/2025

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