Provider Demographics
NPI:1629290028
Name:SWED, NORMAN (LAC)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:
Last Name:SWED
Suffix:
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 1:24 CARY RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-1518
Mailing Address - Country:US
Mailing Address - Phone:516-773-3888
Mailing Address - Fax:516-773-8069
Practice Address - Street 1:714 E PARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-2605
Practice Address - Country:US
Practice Address - Phone:516-431-7972
Practice Address - Fax:516-431-7944
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002005171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2G7323OtherBLUE CROSS BLUE SHIELD
NY2G7322OtherBLUE CROSS BLUE SHIELD
NYP2748962OtherOXFORD