Healthcare Provider Details

I. General information

NPI: 1619003498
Provider Name (Legal Business Name): JEAN M DOMBROSKI L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 MAIN ST
SCOTTSVILLE NY
14546-1232
US

IV. Provider business mailing address

1748 WALKER RD
PALMYRA NY
14522-9380
US

V. Phone/Fax

Practice location:
  • Phone: 585-889-9530
  • Fax:
Mailing address:
  • Phone: 315-573-0103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number003363
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: