Provider Demographics
NPI:1629262431
Name:KUNTZ, EDWARD THOMAS JR (LAC)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:THOMAS
Last Name:KUNTZ
Suffix:JR
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SUNSET TRL
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-6710
Mailing Address - Country:US
Mailing Address - Phone:518-745-8272
Mailing Address - Fax:
Practice Address - Street 1:19 HOMER AVE
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-2039
Practice Address - Country:US
Practice Address - Phone:518-798-4322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001066-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist