Provider Demographics
NPI:1104998335
Name:RAPPEPORT, SALLY (LAC)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:RAPPEPORT
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 UNION ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-1418
Mailing Address - Country:US
Mailing Address - Phone:718-398-5284
Mailing Address - Fax:718-398-5284
Practice Address - Street 1:911 UNION ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-1418
Practice Address - Country:US
Practice Address - Phone:718-398-5284
Practice Address - Fax:718-398-5284
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000968171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist