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General NPI Number Information
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NPI Number | 1487097937
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Entity Type | Individual
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Provider Name | CHRISTINA ERIN WALLACE L.AC.
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Gender | Female
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Dates
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Enumeration Date | 04/15/2013
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Last Update Date | 12/07/2021
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Provider Practice Location Address
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Address Line | 200 S. BROADWAY SOUTH BUILDING, SUITE #2-3
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City | TARRYTOWN
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State | NY
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Zip | 10591-4500
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Country | US
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Telephone | 914-246-0148
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Fax |
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Provider Business Mailing Address
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Address Line | 916 LYMAN AVE
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City | PEEKSKILL
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State | NY
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Zip | 10566-1820
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Country | US
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Telephone | 914-246-0148
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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 | 006008
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License Number State | NY
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