Provider Demographics
NPI:1619366754
Name:FREE RANGE ACUPUNCTURE
Entity Type:Organization
Organization Name:FREE RANGE ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TABITHA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:SILVER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LAC
Authorized Official - Phone:646-785-4243
Mailing Address - Street 1:615 W 113TH ST
Mailing Address - Street 2:#66
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-7970
Mailing Address - Country:US
Mailing Address - Phone:646-785-4243
Mailing Address - Fax:
Practice Address - Street 1:3111 BROADWAY
Practice Address - Street 2:SUITE A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4602
Practice Address - Country:US
Practice Address - Phone:347-699-0858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-13
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005270171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty