Provider Demographics
NPI:1720357007
Name:OJIMA, KELSEY (LAC)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:OJIMA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 BROAD ST
Mailing Address - Street 2:STE 1401
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004-2209
Mailing Address - Country:US
Mailing Address - Phone:212-943-4999
Mailing Address - Fax:
Practice Address - Street 1:80 BROAD ST
Practice Address - Street 2:STE 1401
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-2209
Practice Address - Country:US
Practice Address - Phone:212-943-4999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-15
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60248784171100000X
WAMA60194661225700000X
NY005531-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist