MEDICARE: ANDREW PACHOLYK 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	002865-1	NY

General Provider Information

NPI Number	:	1831408772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW PACHOLYK L.AC

Provider Business Mailing Address
First Line	:	161 W 16TH ST
Second Line	:	5J
City	:	NEW YORK
State	:	NY
Zip	:	10011-6286
Country	:	US
Telephone Number	:	917-843-3623
Fax Number	:

Provider Business Practice Location Address
First Line	:	161 W 16TH ST
Second Line	:	5J
City	:	NEW YORK
State	:	NY
Zip	:	10011-6286
Country	:	US
Telephone Number	:	917-843-3623
Fax Number	:

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

Provider Enumeration Date	:	09/27/2010
Last Update Date	:	09/27/2010

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