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General NPI Number Information
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NPI Number | 1952862583
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Entity Type | Individual
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Provider Name | KIMBERLY M SPATAFORA L.AC
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Gender | Female
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Dates
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Enumeration Date | 03/27/2019
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Last Update Date | 03/27/2019
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Provider Practice Location Address
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Address Line | 53345 MAIN RD STE 6-1
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City | SOUTHOLD
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State | NY
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Zip | 11971-4643
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Country | US
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Telephone | 643-765-2100
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Fax |
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Provider Business Mailing Address
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Address Line | 403 15TH ST
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City | WEST BABYLON
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State | NY
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Zip | 11704-2607
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Country | US
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Telephone | 631-428-8413
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Fax |
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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 | 006506
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License Number State | NY
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