Provider Demographics
NPI:1639469125
Name:LOTOCKE, KIMBERLY ANN (LAC)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ANN
Last Name:LOTOCKE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:254 ROUTE 17K STE 203
Mailing Address - Street 2:WEST WING BUILDING
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-8300
Mailing Address - Country:US
Mailing Address - Phone:845-567-9190
Mailing Address - Fax:845-567-9197
Practice Address - Street 1:254 ROUTE 17K STE 203
Practice Address - Street 2:WEST WING BUILDING
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-8300
Practice Address - Country:US
Practice Address - Phone:845-567-9190
Practice Address - Fax:845-567-9197
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002947171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist