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General NPI Number Information
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NPI Number | 1942780036
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Entity Type | Organization
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Legal Business Name | ACUPUNCTURE IS MY LIFE, PLLC.
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Dates
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Enumeration Date | 08/17/2018
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Last Update Date | 08/17/2018
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Provider Practice Location Address
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Address Line | 24711 UNION TPKE
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City | BELLEROSE
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State | NY
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Zip | 11426-1846
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Country | US
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Telephone | 888-607-3360
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Fax | 888-651-0877
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Provider Business Mailing Address
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Address Line | 24711 UNION TPKE
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City | BELLEROSE
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State | NY
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Zip | 11426-1846
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Country | US
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Telephone | 888-607-3360
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Fax | 888-651-0877
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Authorized Official
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Title or Position | MEMBER
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Name | LEROY LOTT
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Credential | L.AC.
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Telephone | 888-607-3360
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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 | 005011
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License Number State | NY
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