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General NPI Number Information
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NPI Number | 1700161486
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Entity Type | Organization
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Legal Business Name | ACUPUNCTURE CARE OF WNY
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Dates
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Enumeration Date | 10/13/2011
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Last Update Date | 10/13/2011
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Provider Practice Location Address
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Address Line | 656 ELMWOOD AVE.
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City | BUFFALO
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State | NY
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Zip | 14222
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Country | US
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Telephone | 716-883-0515
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Fax | 716-883-8764
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Provider Business Mailing Address
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Address Line | 656 ELMWOOD AVE.
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City | BUFFALO
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State | NY
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Zip | 14222
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Country | US
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Telephone | 716-883-0515
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Fax | 716-883-8764
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Authorized Official
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Title or Position | LICENSED ACUPUNCTURIST
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Name | MR. MARC IANNACCONE
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Credential | L.AC., M.A.
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Telephone | 716-883-0515
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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 | 003762
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License Number State | NY
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