MEDICARE: 16TH STREET ACUPUNCTURE PLLC

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	003606-1	NY

General Provider Information

NPI Number	:	1699103655
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	16TH STREET ACUPUNCTURE PLLC

Provider Business Mailing Address
First Line	:	205 E 16TH ST
Second Line	:	M2A
City	:	NEW YORK
State	:	NY
Zip	:	10003-3746
Country	:	US
Telephone Number	:	646-221-6535
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 E 16TH ST
Second Line	:	M2A
City	:	NEW YORK
State	:	NY
Zip	:	10003-3746
Country	:	US
Telephone Number	:	646-221-6535
Fax Number	:

Authorized Official
Title or Position	:	BILLING REPRESENTATIVE
Name	:	MS. DEBORAH HILDERLEY
Credential	:
Telephone Number	:	352-683-3855

Provider Enumeration Date	:	10/29/2013
Last Update Date	:	10/29/2013

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