MEDICARE: SUSAN MARIE BENEDEK LAC, MAOM, RN

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	163W00000X	Registered Nurse	155916	MA
2	171100000X	Acupuncturist	222746	MA

General Provider Information

NPI Number	:	1881873040
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN MARIE BENEDEK LAC, MAOM, RN

Provider Business Mailing Address
First Line	:	74 FAUNCE CORNER RD
Second Line	:	SUITE 630
City	:	N DARTMOUTH
State	:	MA
Zip	:	02747-1209
Country	:	US
Telephone Number	:	508-996-0013
Fax Number	:	508-996-0013

Provider Business Practice Location Address
First Line	:	74 FAUNCE CORNER RD
Second Line	:	SUITE 630
City	:	N DARTMOUTH
State	:	MA
Zip	:	02747-1209
Country	:	US
Telephone Number	:	508-996-0013
Fax Number	:	508-996-0013

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

Provider Enumeration Date	:	10/24/2007
Last Update Date	:	10/09/2019

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