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NPI Code Detail

MEDICARE: KELLY ROSE L.AC.

MEDICARE: KELLY ROSE 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
1171100000XAcupuncturist001154NY

General Provider Information

NPI Number : 1295618619
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY ROSE L.AC.
Provider Business Mailing Address
First Line : 15 CLUBSIDE DR
Second Line :
City : WOODMERE
State : NY
Zip : 11598-1363
Country : US
Telephone Number : 917-582-2031
Fax Number :
Provider Business Practice Location Address
First Line : 11 IRVING PL
Second Line :
City : WOODMERE
State : NY
Zip : 11598-1256
Country : US
Telephone Number : 917-582-2031
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2025
Last Update Date : 07/31/2025

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