Provider Demographics
NPI:1245565589
Name:SUMOWICZ, ADRIENNE (LAC, OMD)
Entity Type:Individual
Prefix:MISS
First Name:ADRIENNE
Middle Name:
Last Name:SUMOWICZ
Suffix:
Gender:F
Credentials:LAC, OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3704 92ND ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-7930
Mailing Address - Country:US
Mailing Address - Phone:718-505-5414
Mailing Address - Fax:
Practice Address - Street 1:3704 92ND ST
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7930
Practice Address - Country:US
Practice Address - Phone:718-505-5414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001677-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist