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General NPI Number Information
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NPI Number | 1902133978
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Entity Type | Individual
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Provider Name | MARK DONNELLY L.AC., MS
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Gender | Male
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Dates
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Enumeration Date | 11/11/2009
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Last Update Date | 11/11/2009
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Provider Practice Location Address
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Address Line | 177 CONKLIN ST
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City | FARMINGDALE
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State | NY
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Zip | 11735-2501
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Country | US
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Telephone | 516-249-3236
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Fax | 516-249-8514
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Provider Business Mailing Address
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Address Line | 13 CIRCLE LN
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City | LEVITTOWN
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State | NY
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Zip | 11756-2703
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Country | US
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Telephone | 516-735-1699
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Fax | 516-249-8514
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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 | 001633-1
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License Number State | NY
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