Provider Demographics
NPI:1700051463
Name:SPINA-HASELOFF, PEGGY ANN (LAC MTOM)
Entity Type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:ANN
Last Name:SPINA-HASELOFF
Suffix:
Gender:F
Credentials:LAC MTOM
Other - Prefix:MS
Other - First Name:PEGGY
Other - Middle Name:
Other - Last Name:SPINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC MTOM
Mailing Address - Street 1:115 PRINCE ST
Mailing Address - Street 2:2E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012
Mailing Address - Country:US
Mailing Address - Phone:212-674-8885
Mailing Address - Fax:
Practice Address - Street 1:115 PRINCE ST
Practice Address - Street 2:2E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012
Practice Address - Country:US
Practice Address - Phone:212-674-8885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0007131171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist