Basic Information
| Provider Information | |||||||||
| NPI: | 1700161486 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ACUPUNCTURE CARE OF WNY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 656 ELMWOOD AVE. | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168830515 | ||||||||
| FaxNumber: | 7168838764 | ||||||||
| Practice Location | |||||||||
| Address1: | 656 ELMWOOD AVE. | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168830515 | ||||||||
| FaxNumber: | 7168838764 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2011 | ||||||||
| LastUpdateDate: | 10/13/2011 | ||||||||
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| AuthorizedOfficialLastName: | IANNACCONE | ||||||||
| AuthorizedOfficialFirstName: | MARC | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | LICENSED ACUPUNCTURIST | ||||||||
| AuthorizedOfficialTelephone: | 7168830515 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | L.AC., M.A. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171100000X | 003762 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Acupuncturist |
No ID Information.