Provider Demographics
NPI:1467014209
Name:GEORGE, OCA T (LAC)
Entity Type:Individual
Prefix:MS
First Name:OCA
Middle Name:T
Last Name:GEORGE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 E 168TH ST APT F
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-3839
Mailing Address - Country:US
Mailing Address - Phone:646-326-4223
Mailing Address - Fax:
Practice Address - Street 1:5030 BROADWAY STE 644
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-1616
Practice Address - Country:US
Practice Address - Phone:929-361-3735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00137400171100000X
NY006057171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist