Provider Demographics
NPI:1164283347
Name:STACEY SIMONE ACUPUNCTURE, P.C
Entity Type:Organization
Organization Name:STACEY SIMONE ACUPUNCTURE, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, ACUPUNCTURIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMONE
Authorized Official - Suffix:
Authorized Official - Credentials:DAC, DIPL AC
Authorized Official - Phone:631-766-2350
Mailing Address - Street 1:4 SAGEBRUSH LN
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-3934
Mailing Address - Country:US
Mailing Address - Phone:631-766-2350
Mailing Address - Fax:
Practice Address - Street 1:277 INDIAN HEAD RD
Practice Address - Street 2:
Practice Address - City:KINGS PARK
Practice Address - State:NY
Practice Address - Zip Code:11754-4810
Practice Address - Country:US
Practice Address - Phone:631-813-8600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty