MEDICARE: SAHESER OZLEM DUMAN LAC.

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	25MZ00087800	NJ
2	171100000X	Acupuncturist	004070	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	25MZ00087800	OTHER	NJ	ACUPUNCTURE STATE LICENSE
2	004070	OTHER	NY	ACUPUNCTURE STATE LICENSE

General Provider Information

NPI Number	:	1548514821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAHESER OZLEM DUMAN LAC.

Provider Business Mailing Address
First Line	:	1862 E 14TH ST
Second Line	:	APT 5H
City	:	BROOKLYN
State	:	NY
Zip	:	11229-2852
Country	:	US
Telephone Number	:	347-400-3282
Fax Number	:

Provider Business Practice Location Address
First Line	:	1862 E 14TH ST
Second Line	:	APT:5 H
City	:	BROOKLYN
State	:	NY
Zip	:	11229-2852
Country	:	US
Telephone Number	:	347-400-3282
Fax Number	:

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

Provider Enumeration Date	:	11/07/2012
Last Update Date	:	11/07/2012

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