Healthcare Provider Details

I. General information

NPI: 1316143290
Provider Name (Legal Business Name): MR. JERRY MARTIN KANTOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JERRY MARTIN KANTOR LIC. AC., MMHS

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 WASHINGTON ST. VITAL FORCE HEALTH CARE, SUITE 380
WELLESLEY HILLS MA
02481
US

IV. Provider business mailing address

628 SOUTH ST 2
ROSLINDALE MA
02131-1716
US

V. Phone/Fax

Practice location:
  • Phone: 781-431-1221
  • Fax: 781-305-2077
Mailing address:
  • Phone: 617-327-3227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number143
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: