Provider Demographics
NPI:1073206314
Name:SOUTH SHORE ACUPUNCTURE
Entity Type:Organization
Organization Name:SOUTH SHORE ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED ACUPUNCTURIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIN-SIEGELSON
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:516-510-3813
Mailing Address - Street 1:2786 ESSEX CT
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-2607
Mailing Address - Country:US
Mailing Address - Phone:516-510-3813
Mailing Address - Fax:
Practice Address - Street 1:1 S MARION PL
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-5300
Practice Address - Country:US
Practice Address - Phone:516-415-7348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty