MEDICARE: MS. IOANA BOAMBES L.AC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	004190	NY

General Provider Information

NPI Number	:	1184998791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. IOANA BOAMBES L.AC.

Provider Business Mailing Address
First Line	:	585 ELK CREEK RD
Second Line	:
City	:	HALCOTT CENTER
State	:	NY
Zip	:	12430-1446
Country	:	US
Telephone Number	:	646-644-7080
Fax Number	:

Provider Business Practice Location Address
First Line	:	585 ELK CREEK RD
Second Line	:
City	:	HALCOTT CENTER
State	:	NY
Zip	:	12430-1446
Country	:	US
Telephone Number	:	646-446-7080
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2012
Last Update Date	:	09/30/2021

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