Provider Demographics
NPI:1568800928
Name:LOTT, LEROY (L AC)
Entity Type:Individual
Prefix:MR
First Name:LEROY
Middle Name:
Last Name:LOTT
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12528 QUEENS BLVD
Mailing Address - Street 2:SUITE 427
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-1503
Mailing Address - Country:US
Mailing Address - Phone:888-607-3360
Mailing Address - Fax:888-651-0877
Practice Address - Street 1:24711 UNION TPKE
Practice Address - Street 2:
Practice Address - City:BELLEROSE
Practice Address - State:NY
Practice Address - Zip Code:11426-1846
Practice Address - Country:US
Practice Address - Phone:888-607-3360
Practice Address - Fax:888-651-0877
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-07
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005011171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist