Provider Demographics
NPI:1326337700
Name:PODRECCA, ABIGAIL MARY (LAC)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:MARY
Last Name:PODRECCA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:MARY
Other - Last Name:RIST-PODRECCA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:65 OHAYO MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:NY
Mailing Address - Zip Code:12498-1441
Mailing Address - Country:US
Mailing Address - Phone:914-466-4586
Mailing Address - Fax:
Practice Address - Street 1:65 OHAYO MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:NY
Practice Address - Zip Code:12498-1441
Practice Address - Country:US
Practice Address - Phone:914-466-4586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000558-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist