Provider Demographics
NPI:1891233631
Name:DUFFY, KATHRYN (LAC)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:
Last Name:DUFFY
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 1:1534 ERICSON PL APT 5H
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-5464
Mailing Address - Country:US
Mailing Address - Phone:646-260-1719
Mailing Address - Fax:
Practice Address - Street 1:139 FULTON ST RM 208
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-2538
Practice Address - Country:US
Practice Address - Phone:646-260-1719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005920171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist