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General NPI Number Information
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NPI Number | 1760917678
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Entity Type | Organization
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Legal Business Name | AMALIA HADDAD LICENSED ACUPUNCTURIST, PC
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Dates
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Enumeration Date | 04/28/2017
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Last Update Date | 04/28/2017
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Provider Practice Location Address
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Address Line | 25 GETTYSBURG DR
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-8034
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Country | US
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Telephone | 646-322-0526
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Fax |
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Provider Business Mailing Address
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Address Line | 25 GETTYSBURG DR
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-8034
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Country | US
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Telephone | 646-322-0526
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | AMALIA HADDAD
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Credential | L.AC.
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Telephone | 646-322-0526
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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 | 1101
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License Number State | NY
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