Provider Demographics
NPI:1063885242
Name:MCGILVERY, DEVIN (LAC, LMT)
Entity type:Individual
Prefix:
First Name:DEVIN
Middle Name:
Last Name:MCGILVERY
Suffix:
Gender:M
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 23RD AVE
Mailing Address - Street 2:UNIT 100
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-1532
Mailing Address - Country:US
Mailing Address - Phone:917-868-2480
Mailing Address - Fax:
Practice Address - Street 1:3801 23RD AVE
Practice Address - Street 2:UNIT 100
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-1532
Practice Address - Country:US
Practice Address - Phone:917-868-2480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005637171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist