MEDICARE: RITA FAYDENGOLD 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	002725	NY

General Provider Information

NPI Number	:	1699813162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RITA FAYDENGOLD L.AC.

Provider Business Mailing Address
First Line	:	9 MURDOCK CT
Second Line	:	APARTMENT 5E
City	:	BROOKLYN
State	:	NY
Zip	:	11223-6449
Country	:	US
Telephone Number	:	917-312-7577
Fax Number	:	718-437-2711

Provider Business Practice Location Address
First Line	:	415 BEVERLEY RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-3153
Country	:	US
Telephone Number	:	718-437-6500
Fax Number	:	718-437-2811

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

Provider Enumeration Date	:	02/04/2007
Last Update Date	:	07/08/2007

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