Healthcare Provider Details

I. General information

NPI: 1184923476
Provider Name (Legal Business Name): JACQUELINE MARIE CIPOLLA L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2011
Last Update Date: 03/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 STERLING PL APT 1L
BROOKLYN NY
11216-3860
US

IV. Provider business mailing address

677 STERLING PL APT 1L
BROOKLYN NY
11216-3860
US

V. Phone/Fax

Practice location:
  • Phone: 646-246-1514
  • Fax:
Mailing address:
  • Phone: 646-246-1514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number004545
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: