Provider Demographics
NPI:1760770465
Name:WEENING, MARY FATIMAH (LAC)
Entity Type:Individual
Prefix:MS
First Name:MARY FATIMAH
Middle Name:
Last Name:WEENING
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 SULLIVAN ST
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-1354
Mailing Address - Country:US
Mailing Address - Phone:646-485-5229
Mailing Address - Fax:
Practice Address - Street 1:214 SULLIVAN ST
Practice Address - Street 2:SUITE 3B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-1354
Practice Address - Country:US
Practice Address - Phone:646-485-5229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004591171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist