Provider Demographics
NPI:1699216408
Name:MENARD ACUPUNCTURE, P.C.
Entity type:Organization
Organization Name:MENARD ACUPUNCTURE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MENARD
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:631-899-4112
Mailing Address - Street 1:39 DIVISION ST
Mailing Address - Street 2:PO BOX 2271
Mailing Address - City:SAG HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11963-3156
Mailing Address - Country:US
Mailing Address - Phone:631-899-4112
Mailing Address - Fax:
Practice Address - Street 1:39 DIVISION ST
Practice Address - Street 2:
Practice Address - City:SAG HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11963-3156
Practice Address - Country:US
Practice Address - Phone:631-899-4112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4842171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty