Provider Demographics
NPI:1104956671
Name:ROCKY COAST FAMILY ACUPUNCTURE, PA
Entity type:Organization
Organization Name:ROCKY COAST FAMILY ACUPUNCTURE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:SHER
Authorized Official - Last Name:STEIN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:207-775-2059
Mailing Address - Street 1:500 FOREST AVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-1541
Mailing Address - Country:US
Mailing Address - Phone:207-775-2059
Mailing Address - Fax:
Practice Address - Street 1:500 FOREST AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-1541
Practice Address - Country:US
Practice Address - Phone:207-775-2059
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAC237171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME061669OtherANTHEM PIN #