Provider Demographics
NPI:1861665036
Name:MA, FIONA (LAC, MSTOM)
Entity Type:Individual
Prefix:MS
First Name:FIONA
Middle Name:
Last Name:MA
Suffix:
Gender:F
Credentials:LAC, MSTOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 MAIN ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:TUCKAHOE
Mailing Address - State:NY
Mailing Address - Zip Code:10707-2904
Mailing Address - Country:US
Mailing Address - Phone:917-299-8762
Mailing Address - Fax:
Practice Address - Street 1:62 MAIN ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:TUCKAHOE
Practice Address - State:NY
Practice Address - Zip Code:10707-2904
Practice Address - Country:US
Practice Address - Phone:917-299-8762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-09
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001976-2171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist