Provider Demographics
NPI:1497027973
Name:O'MALLEY, MICHAEL PHILIP (MS, L AC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:PHILIP
Last Name:O'MALLEY
Suffix:
Gender:M
Credentials:MS, L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:552 DRIGGS AVE
Mailing Address - Street 2:APT. 5
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-2951
Mailing Address - Country:US
Mailing Address - Phone:646-226-6655
Mailing Address - Fax:
Practice Address - Street 1:80 8TH AVE
Practice Address - Street 2:SUITE 1304
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-5126
Practice Address - Country:US
Practice Address - Phone:646-226-6655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-31
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004626171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist