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General NPI Number Information
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NPI Number | 1790954634
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Entity Type | Individual
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Provider Name | JEREMY E REIDY DOM, AP, L.AC
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Gender | Male
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Dates
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Enumeration Date | 02/25/2008
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Last Update Date | 08/23/2009
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Provider Practice Location Address
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Address Line | 611 W EDWIN ST THE REIDY CENTER FOR ALTERNATIVE MEDICINE & WELLNESS
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-4909
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Country | US
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Telephone | 570-322-6824
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Fax | 570-322-3733
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Provider Business Mailing Address
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Address Line | 611 W EDWIN ST THE REIDY CENTER FOR ALTERNATIVE MEDICINE & WELLNESS
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City | WILLIAMSPORT
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State | PA
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Zip | 17701-4909
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Country | US
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Telephone | 570-322-6824
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Fax | 570-322-3733
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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 | AP2482
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AK000913
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License Number State | PA
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