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General NPI Number Information
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NPI Number | 1538990791
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Entity Type | Organization
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Legal Business Name | DESRAVINES ACUPUNCTURE PC
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Dates
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Enumeration Date | 08/09/2024
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Last Update Date | 08/09/2024
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Provider Practice Location Address
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Address Line | 200 OLD COUNTRY RD STE 140
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City | MINEOLA
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State | NY
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Zip | 11501-4273
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Country | US
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Telephone | 516-794-2200
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Fax | 718-949-1576
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Provider Business Mailing Address
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Address Line | 335 OCEAN PKWY
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City | BROOKLYN
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State | NY
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Zip | 11218-4104
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Country | US
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Telephone | 516-794-2200
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Fax | 718-949-1576
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Authorized Official
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Title or Position | OWNER
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Name | MEDZDABE DESRAVINES
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Credential | LAC
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Telephone | 516-794-2200
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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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