Healthcare Provider Details

I. General information

NPI: 1255295762
Provider Name (Legal Business Name): KELSEY LUDWIG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1291 GREENE AVE APT 2R
BROOKLYN NY
11237-4531
US

IV. Provider business mailing address

1291 GREENE AVE APT 2R
BROOKLYN NY
11237-4531
US

V. Phone/Fax

Practice location:
  • Phone: 516-448-7491
  • Fax:
Mailing address:
  • Phone: 516-448-7491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number007116-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: