MEDICARE: LI MA L.AC., DIPL.OM

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	003547	NY

General Provider Information

NPI Number	:	1790185726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LI MA L.AC., DIPL.OM

Provider Business Mailing Address
First Line	:	2361 61ST ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-2635
Country	:	US
Telephone Number	:	646-515-2228
Fax Number	:

Provider Business Practice Location Address
First Line	:	2361 61ST ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-2635
Country	:	US
Telephone Number	:	646-515-2228
Fax Number	:

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

Provider Enumeration Date	:	08/27/2014
Last Update Date	:	09/13/2018

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