Provider Demographics
NPI:1053634907
Name:SMIESZEK, THERESA EMILY (LAC)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:EMILY
Last Name:SMIESZEK
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 1:40 1ST AVE
Mailing Address - Street 2:#8A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-7630
Mailing Address - Country:US
Mailing Address - Phone:917-543-9775
Mailing Address - Fax:
Practice Address - Street 1:40 1ST AVE
Practice Address - Street 2:#8A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-7630
Practice Address - Country:US
Practice Address - Phone:917-543-9775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-07
Last Update Date:2010-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004201-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist