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General NPI Number Information
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NPI Number | 1154892909
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Entity Type | Organization
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Legal Business Name | LIFE CYCLES CLINIC
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Dates
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Enumeration Date | 12/05/2018
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Last Update Date | 04/05/2022
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Provider Practice Location Address
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Address Line | 839 NEW LOUDON RD STE 1
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City | LATHAM
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State | NY
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Zip | 12110-6101
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Country | US
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Telephone | 518-504-6600
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Fax | 617-221-9734
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Provider Business Mailing Address
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Address Line | 288 SOUTH RIVER ROAD BLDG A, UNIT 1
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City | BEDFORD
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State | NH
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Zip | 03110
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Country | US
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Telephone | 603-399-6600
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Fax | 617-221-9734
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Authorized Official
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Title or Position | CLINIC OWNER
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Name | KATYA GALAY
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Credential | LAC
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Telephone | 518-504-6600
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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 |
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License Number State |
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