Provider Demographics
NPI:1063589794
Name:MYERSON, JOHN G (LIC AC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:G
Last Name:MYERSON
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 LEXINGTON ST
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-8219
Mailing Address - Country:US
Mailing Address - Phone:508-879-3002
Mailing Address - Fax:
Practice Address - Street 1:64 LEXINGTON ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-8219
Practice Address - Country:US
Practice Address - Phone:508-879-3002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist