Healthcare Provider Details

I. General information

NPI: 1194424457
Provider Name (Legal Business Name): LAUREN ZUMMO L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 02/27/2023
Certification Date: 02/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16A HUYLER RD
SETAUKET NY
11733-1310
US

IV. Provider business mailing address

16A HUYLER RD
SETAUKET NY
11733-1310
US

V. Phone/Fax

Practice location:
  • Phone: 631-371-9172
  • Fax:
Mailing address:
  • Phone: 631-371-9172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number007271
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: