=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255520813
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LUCY DISKANT L..OM,L.AC., DIPL.OM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2007
-----------------------------------------------------
Last Update Date | 11/02/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 380 RED LION RD STE 204
-----------------------------------------------------
City | HUNTINGDON VALLEY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19006-6451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-939-0974
-----------------------------------------------------
Fax | 267-775-3165
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 380 RED LION RD STE 204
-----------------------------------------------------
City | HUNTINGDON VALLEY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19006-6451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-939-0974
-----------------------------------------------------
Fax | 267-775-3165
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 11946
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | OM000140
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------