Provider Demographics
NPI:1699103655
Name:16TH STREET ACUPUNCTURE PLLC
Entity type:Organization
Organization Name:16TH STREET ACUPUNCTURE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING REPRESENTATIVE
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HILDERLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-683-3855
Mailing Address - Street 1:205 E 16TH ST
Mailing Address - Street 2:M2A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3746
Mailing Address - Country:US
Mailing Address - Phone:646-221-6535
Mailing Address - Fax:
Practice Address - Street 1:205 E 16TH ST
Practice Address - Street 2:M2A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3746
Practice Address - Country:US
Practice Address - Phone:646-221-6535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003606-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty