Provider Demographics
NPI:1609259233
Name:FOLCKOMER, ANNA E (LAC)
Entity Type:Individual
Prefix:MS
First Name:ANNA
Middle Name:E
Last Name:FOLCKOMER
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 1:2056 37TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-1630
Mailing Address - Country:US
Mailing Address - Phone:336-613-6067
Mailing Address - Fax:
Practice Address - Street 1:2056 37TH ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-1630
Practice Address - Country:US
Practice Address - Phone:336-613-6067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005581171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist