Provider Demographics
NPI:1396225207
Name:MOSEMAN, DENNIS (LAC)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:
Last Name:MOSEMAN
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 1:52 8TH ST
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-5402
Mailing Address - Country:US
Mailing Address - Phone:516-647-5404
Mailing Address - Fax:
Practice Address - Street 1:52 8TH ST
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-5402
Practice Address - Country:US
Practice Address - Phone:516-647-5404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001151171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty