MEDICARE: MS. KATHRYN R. NEMIROVSKY 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	004143	NY
2	171100000X	Acupuncturist	U02044	MD

General Provider Information

NPI Number	:	1225369457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHRYN R. NEMIROVSKY L.AC.

Provider Business Mailing Address
First Line	:	22 STUYVESANT ST APT 3
Second Line	:
City	:	KINGSTON
State	:	NY
Zip	:	12401-4110
Country	:	US
Telephone Number	:	631-742-3996
Fax Number	:

Provider Business Practice Location Address
First Line	:	2568A RIVA RD
Second Line	:	SUITE 101
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-7445
Country	:	US
Telephone Number	:	410-224-2328
Fax Number	:

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

Provider Enumeration Date	:	01/28/2010
Last Update Date	:	03/18/2013

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