Healthcare Provider Details

I. General information

NPI: 1326505181
Provider Name (Legal Business Name): SUSAN LEDERFEIND L.AC, MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2019
Last Update Date: 02/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6527 MAIN ST
TRUMBULL CT
06611-1385
US

IV. Provider business mailing address

20 DEEPWOOD CIR
MONROE CT
06468-2632
US

V. Phone/Fax

Practice location:
  • Phone: 203-243-1805
  • Fax:
Mailing address:
  • Phone: 203-243-1805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0000301
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number007097
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: