Provider Demographics
NPI:1689907388
Name:AMRITA ACUPUNCTURE & HERBOLOGY
Entity Type:Organization
Organization Name:AMRITA ACUPUNCTURE & HERBOLOGY
Other - Org Name:SUZANNE L BARRY DOM PC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BARRY
Authorized Official - Suffix:
Authorized Official - Credentials:DOM
Authorized Official - Phone:505-861-0332
Mailing Address - Street 1:219 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BELEN
Mailing Address - State:NM
Mailing Address - Zip Code:87002-4315
Mailing Address - Country:US
Mailing Address - Phone:505-861-0332
Mailing Address - Fax:505-861-0332
Practice Address - Street 1:219 N 4TH ST
Practice Address - Street 2:
Practice Address - City:BELEN
Practice Address - State:NM
Practice Address - Zip Code:87002-4315
Practice Address - Country:US
Practice Address - Phone:505-861-0332
Practice Address - Fax:505-861-0332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-12
Last Update Date:2009-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM497RX2171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1740302447OtherNPI INDIVIDUAL