=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932644689
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELISA SZCZEPANKIEWICZ M.AC, L.AC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2017
-----------------------------------------------------
Last Update Date | 01/04/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19 HOLLY ST
-----------------------------------------------------
City | CRANFORD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07016-2158
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-518-5846
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 505 CENTRAL AVE
-----------------------------------------------------
City | CRANFORD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07016-2303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
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 | 25MZ00124400
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------