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General NPI Number Information
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NPI Number | 1346619459
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Entity Type | Individual
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Provider Name | SHACHAR ADI KORMAN MS LAC
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Gender | Male
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Dates
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Enumeration Date | 09/18/2015
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Last Update Date | 09/18/2015
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Provider Practice Location Address
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Address Line | 5633 DOUGLASTON PKWY
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City | DOUGLASTON
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State | NY
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Zip | 11362-1538
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Country | US
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Telephone | 646-463-1693
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Fax |
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Provider Business Mailing Address
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Address Line | 5633 DOUGLASTON PKWY
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City | DOUGLASTON
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State | NY
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Zip | 11362-1538
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Country | US
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Telephone |
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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 | 005641
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License Number State | NY
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