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General NPI Number Information
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NPI Number | 1821641689
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Entity Type | Organization
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Legal Business Name | KINGSTON COMMUNITY ACUPUNCTURE
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Dates
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Enumeration Date | 07/22/2019
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Last Update Date | 07/22/2019
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Provider Practice Location Address
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Address Line | 280 WALL ST
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City | KINGSTON
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State | NY
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Zip | 12401-3866
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Country | US
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Telephone | 845-339-5653
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Fax |
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Provider Business Mailing Address
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Address Line | 280 WALL ST
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City | KINGSTON
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State | NY
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Zip | 12401-3866
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Country | US
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Telephone | 845-339-5653
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MINYA DEJOHNETTE
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Credential | L. AC.
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Telephone | 845-339-5653
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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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