Provider Demographics
NPI:1821651597
Name:HOOTS, JOSEPH LEE (MSTOM, LAC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:LEE
Last Name:HOOTS
Suffix:
Gender:M
Credentials:MSTOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 JAVA ST APT 2C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-7571
Mailing Address - Country:US
Mailing Address - Phone:347-833-2275
Mailing Address - Fax:
Practice Address - Street 1:3801 23RD AVE STE 100
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-1532
Practice Address - Country:US
Practice Address - Phone:347-833-2275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006499171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist