Provider Demographics
NPI:1629938840
Name:STEFANIE VIDAL ACUPUNCTURE PLLC
Entity type:Organization
Organization Name:STEFANIE VIDAL ACUPUNCTURE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEFANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VIDAL
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:917-684-6743
Mailing Address - Street 1:20 SHELDON DR
Mailing Address - Street 2:
Mailing Address - City:CORNWALL
Mailing Address - State:NY
Mailing Address - Zip Code:12518-1614
Mailing Address - Country:US
Mailing Address - Phone:917-684-6743
Mailing Address - Fax:
Practice Address - Street 1:16 QUAKER AVE STOP 5
Practice Address - Street 2:
Practice Address - City:CORNWALL
Practice Address - State:NY
Practice Address - Zip Code:12518-2113
Practice Address - Country:US
Practice Address - Phone:917-684-6743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-12
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty