Provider Demographics
NPI:1376019372
Name:KIRSCHEN, STEPHANIE B (LAC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:B
Last Name:KIRSCHEN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 N CENTRE AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-3923
Mailing Address - Country:US
Mailing Address - Phone:516-764-7246
Mailing Address - Fax:
Practice Address - Street 1:77 N CENTRE AVE STE 202
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-3923
Practice Address - Country:US
Practice Address - Phone:516-764-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006288171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist