Healthcare Provider Details

I. General information

NPI: 1346623527
Provider Name (Legal Business Name): HAROLDO JEZLER L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 07/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 S BROADWAY STE 300
WHITE PLAINS NY
10605-1841
US

IV. Provider business mailing address

145 MILTON RD
RYE NY
10580-3812
US

V. Phone/Fax

Practice location:
  • Phone: 914-320-5239
  • Fax:
Mailing address:
  • Phone: 914-320-5239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number005592
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: