Provider Demographics
NPI:1700020971
Name:MYERSON, ANN (LIC AC)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:MYERSON
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 RAWSON RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-4404
Mailing Address - Country:US
Mailing Address - Phone:617-232-2046
Mailing Address - Fax:
Practice Address - Street 1:VILLAGE ACUPUNCTURE
Practice Address - Street 2:175 RAWSON ROAD
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445
Practice Address - Country:US
Practice Address - Phone:617-232-2046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-01
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist