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General NPI Number Information
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NPI Number | 1790821239
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Entity Type | Individual
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Provider Name | JONATHAN S THALER NYS L.AC.
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Gender | Male
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1220 N RIDGE RD POB 611
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City | SHRUB OAK
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State | NY
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Zip | 10588-1033
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Country | US
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Telephone | 914-528-8770
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Fax |
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Provider Business Mailing Address
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Address Line | 1220 NORTH RIDGE RD. ,POB 611 POB 611
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City | SHRUB OAK
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State | NY
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Zip | 10588-0611
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Country | US
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Telephone | 914-528-8770
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 000697
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License Number State | NY
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