Provider Demographics
NPI:1174026983
Name:KUPIEC, THOMAS (LAC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:KUPIEC
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:13417-1412
Mailing Address - Country:US
Mailing Address - Phone:315-332-0114
Mailing Address - Fax:
Practice Address - Street 1:7 W WHITESBORO ST UNIT A
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:NY
Practice Address - Zip Code:13495-1635
Practice Address - Country:US
Practice Address - Phone:315-332-0114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-18
Last Update Date:2018-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3759171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty