=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932362290
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAUL MACKAY RIPPEY M.AC., LAC.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2008
-----------------------------------------------------
Last Update Date | 09/14/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 87 UTICA RD
-----------------------------------------------------
City | CLINTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13323-1545
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-843-0414
-----------------------------------------------------
Fax | 315-883-2926
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3129 STATE ROUTE 12B
-----------------------------------------------------
City | DEANSBORO
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13328-1023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-853-3242
-----------------------------------------------------
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 | 001262
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------