Provider Demographics
NPI:1144652165
Name:DOBSEVAGE, BETH (L'AC)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:DOBSEVAGE
Suffix:
Gender:F
Credentials:L'AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 W 109TH ST
Mailing Address - Street 2:SUITE 6H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-2176
Mailing Address - Country:US
Mailing Address - Phone:718-219-1648
Mailing Address - Fax:
Practice Address - Street 1:350 LEXINGTON AVE
Practice Address - Street 2:SUITE 902
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1723
Practice Address - Country:US
Practice Address - Phone:718-219-1648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003217-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist