Healthcare Provider Details

I. General information

NPI: 1104521350
Provider Name (Legal Business Name): MS. IKUGUN BRACKBILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8414 13TH AVE
BROOKLYN NY
11228-3336
US

IV. Provider business mailing address

8639 16TH AVE
BROOKLYN NY
11214-3611
US

V. Phone/Fax

Practice location:
  • Phone: 718-921-2962
  • Fax:
Mailing address:
  • Phone: 917-496-2962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number007940
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: