Provider Demographics
NPI:1568645927
Name:FREEMAN, DOUGLAS S (LAC)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:S
Last Name:FREEMAN
Suffix:
Gender:M
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 1:80 5TH AVE
Mailing Address - Street 2:SUITE 906
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8002
Mailing Address - Country:US
Mailing Address - Phone:212-874-0898
Mailing Address - Fax:212-675-1417
Practice Address - Street 1:80 5TH AVE
Practice Address - Street 2:SUITE 906
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8002
Practice Address - Country:US
Practice Address - Phone:212-874-0898
Practice Address - Fax:212-675-1417
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-08
Last Update Date:2007-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001914171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist