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General NPI Number Information
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NPI Number | 1841741295
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Entity Type | Organization
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Legal Business Name | GERALD WEIR, LAC
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Dates
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Enumeration Date | 10/20/2016
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Last Update Date | 10/20/2016
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Provider Practice Location Address
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Address Line | 125 N CENTRAL AVE
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City | VALLEY STREAM
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State | NY
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Zip | 11580-3822
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Country | US
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Telephone | 516-763-0049
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Fax |
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Provider Business Mailing Address
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Address Line | 1357 EAST 69TH STREET
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City | BROOKLYN
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State | NY
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Zip | 11234
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Country | US
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Telephone | 516-763-0049
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Fax |
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Authorized Official
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Title or Position | EMPLOYEE
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Name | IRINA KAZANSKAYA
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Credential | LAC
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Telephone | 516-763-0049
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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 | 002628
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License Number State | NY
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