Provider Demographics
NPI:1124665823
Name:WOODSTOCK, AMY (LAC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:WOODSTOCK
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 1:305 E 55TH ST APT 108
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4148
Mailing Address - Country:US
Mailing Address - Phone:212-224-0087
Mailing Address - Fax:
Practice Address - Street 1:305 E 55TH ST APT 108
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4148
Practice Address - Country:US
Practice Address - Phone:212-224-0087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005825171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist