Provider Demographics
NPI:1598918062
Name:ASTEMBORSKI, JACQUELINE ANN (MAC)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ANN
Last Name:ASTEMBORSKI
Suffix:
Gender:F
Credentials:MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 ASPEN DR
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:MD
Mailing Address - Zip Code:21074-1713
Mailing Address - Country:US
Mailing Address - Phone:410-206-8826
Mailing Address - Fax:
Practice Address - Street 1:2730 ASPEN DR
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:MD
Practice Address - Zip Code:21074-1713
Practice Address - Country:US
Practice Address - Phone:410-206-8826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU-01448171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist