Provider Demographics
NPI:1891278206
Name:WATKINS, TONY (LAC)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:
Last Name:WATKINS
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 1:100 W 92ND ST APT 21E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-7504
Mailing Address - Country:US
Mailing Address - Phone:917-484-3249
Mailing Address - Fax:
Practice Address - Street 1:32 UNION SQ E # 615N
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3209
Practice Address - Country:US
Practice Address - Phone:917-484-3249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006353171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist