Provider Demographics
NPI:1194263798
Name:PAIGE BOURASSA ACUPUNCTURE NYC
Entity type:Organization
Organization Name:PAIGE BOURASSA ACUPUNCTURE NYC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:WESTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-641-3462
Mailing Address - Street 1:175 KENT AVE APT 621
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11249-5289
Mailing Address - Country:US
Mailing Address - Phone:917-744-0417
Mailing Address - Fax:
Practice Address - Street 1:24-32 UNION SQUARE EAST
Practice Address - Street 2:SUITE 1115
Practice Address - City:NY
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:917-744-0417
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25004684171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty