Provider Demographics
NPI:1558816611
Name:HAUGEN, TONI JAY (LAC MSTOM)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:JAY
Last Name:HAUGEN
Suffix:
Gender:F
Credentials:LAC MSTOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-2416
Mailing Address - Country:US
Mailing Address - Phone:716-218-9338
Mailing Address - Fax:
Practice Address - Street 1:135 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-2416
Practice Address - Country:US
Practice Address - Phone:716-218-9338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25004988171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist