Provider Demographics
NPI:1750672374
Name:GOUSSE, EDWARD P (LAC)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:P
Last Name:GOUSSE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 W 38TH ST STE 601
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-5504
Mailing Address - Country:US
Mailing Address - Phone:631-778-5064
Mailing Address - Fax:
Practice Address - Street 1:29 W 38TH ST STE 601
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-5504
Practice Address - Country:US
Practice Address - Phone:631-778-5064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-30
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004494171100000X
NY004494-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist