Provider Demographics
NPI:1275813099
Name:TAMBERG, BETTY ANN (MSTOM, LAC)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:ANN
Last Name:TAMBERG
Suffix:
Gender:F
Credentials:MSTOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 OCEAN PKWY
Mailing Address - Street 2:APT. 2F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-1548
Mailing Address - Country:US
Mailing Address - Phone:917-968-8503
Mailing Address - Fax:718-436-0486
Practice Address - Street 1:825 CATON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-2601
Practice Address - Country:US
Practice Address - Phone:917-968-8503
Practice Address - Fax:718-436-0486
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004361-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist