MEDICARE: WISITSEE MONAHAN LAC, PHD

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	001306	NY

General Provider Information

NPI Number	:	1205066172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WISITSEE MONAHAN LAC, PHD

Provider Business Mailing Address
First Line	:	2019 NOSTRAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-2549
Country	:	US
Telephone Number	:	718-434-0711
Fax Number	:

Provider Business Practice Location Address
First Line	:	2019 NOSTRAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-2549
Country	:	US
Telephone Number	:	718-434-0711
Fax Number	:

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

Provider Enumeration Date	:	07/24/2009
Last Update Date	:	07/24/2009

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