=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558738328
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AVENUE ACUPUNCTURE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2015
-----------------------------------------------------
Last Update Date | 08/27/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 43 DURKEE ST STE 600A
-----------------------------------------------------
City | PLATTSBURGH
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12901-2958
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-569-6275
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 43 DURKEE ST STE 600A
-----------------------------------------------------
City | PLATTSBURGH
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12901-2958
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-569-6275
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED ACUPUNCTURIST
-----------------------------------------------------
Name | DANIELLE M DUPELL
-----------------------------------------------------
Credential | L.AC.
-----------------------------------------------------
Telephone | 518-569-6275
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 005572
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------