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General NPI Number Information
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NPI Number | 1730944380
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Entity Type | Organization
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Legal Business Name | INNER WATERS ACUPUNCTURE, PLLC
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Dates
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Enumeration Date | 02/13/2024
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Last Update Date | 02/13/2024
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Provider Practice Location Address
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Address Line | 360 BROADWAY
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City | KINGSTON
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State | NY
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Zip | 12401-5150
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Country | US
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Telephone | 845-745-8006
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Fax |
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Provider Business Mailing Address
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Address Line | 56 LINDERMAN AVE
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City | KINGSTON
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State | NY
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Zip | 12401-5350
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Country | US
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Telephone | 845-745-8006
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. EVAN MARKS
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Credential | LAC, MACOM
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Telephone | 845-745-8006
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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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