=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881782571
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SANDY CAROLYN CAMPER M.AC., L.AC.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3 COMPUTER DR W STE 126A
-----------------------------------------------------
City | ALBANY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12205-1621
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-458-9113
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 254
-----------------------------------------------------
City | BERLIN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12022-0254
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-658-0594
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 002402-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------