Provider Demographics
NPI:1609942135
Name:WADSWORTH, WILLIAM MERRICK (L AC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:MERRICK
Last Name:WADSWORTH
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 1:119 PONDFIELD RD WEST
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708
Mailing Address - Country:US
Mailing Address - Phone:914-787-9570
Mailing Address - Fax:
Practice Address - Street 1:119 PONDFIELD RD W
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-2138
Practice Address - Country:US
Practice Address - Phone:914-787-9570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002153-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist