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General NPI Number Information
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NPI Number | 1093907719
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Entity Type | Individual
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Provider Name | SIMONE SONIA DECLERCQ L.AC.
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Gender | Female
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Dates
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Enumeration Date | 08/16/2007
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Last Update Date | 08/16/2007
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Provider Practice Location Address
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Address Line | 240 CENTRAL PARK S SUITE 2P
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City | NEW YORK
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State | NY
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Zip | 10019-1457
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Country | US
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Telephone | 347-754-9763
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Fax |
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Provider Business Mailing Address
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Address Line | 12112 103RD AVE
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City | SOUTH RICHMOND HILL
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State | NY
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Zip | 11419-2120
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Country | US
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Telephone | 347-754-9763
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 003098
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License Number State | NY
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