MEDICARE: MICHELA GIOVANNA TEBANO 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	25 005135

General Provider Information

NPI Number	:	1760817696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELA GIOVANNA TEBANO LAC

Provider Business Mailing Address
First Line	:	535 W 23RD ST
Second Line	:	PH4PS
City	:	NEW YORK
State	:	NY
Zip	:	10011-1144
Country	:	US
Telephone Number	:	845-674-7632
Fax Number	:

Provider Business Practice Location Address
First Line	:	535 W 23RD ST
Second Line	:	PH4PS
City	:	NEW YORK
State	:	NY
Zip	:	10011-1144
Country	:	US
Telephone Number	:	845-674-7632
Fax Number	:

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

Provider Enumeration Date	:	09/11/2013
Last Update Date	:	09/11/2013

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Directions to “ MICHELA GIOVANNA TEBANO LAC” Practice Location

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