MEDICARE: PAIN FREE ACUPUNCTURE, P.C.

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	002904	NY

General Provider Information

NPI Number	:	1497091862
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAIN FREE ACUPUNCTURE, P.C.

Provider Business Mailing Address
First Line	:	1835 RICHMOND RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-2560
Country	:	US
Telephone Number	:	917-612-5482
Fax Number	:

Provider Business Practice Location Address
First Line	:	1835 RICHMOND RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-2560
Country	:	US
Telephone Number	:	917-612-5482
Fax Number	:

Authorized Official
Title or Position	:	LICENSED ACUPUNCTURIST
Name	:	ELMIRA SAMKOVA
Credential	:	ACUPUNCTURIST
Telephone Number	:	917-612-5482

Provider Enumeration Date	:	12/12/2012
Last Update Date	:	12/13/2012

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