Provider Demographics
NPI:1912371857
Name:VICTOR ACUPUNCTURE, PLLC
Entity Type:Organization
Organization Name:VICTOR ACUPUNCTURE, PLLC
Other - Org Name:LONGEVITY COMPLEMENTARY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF CHINESE MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:JOELLE
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DACM, LAC
Authorized Official - Phone:315-310-5538
Mailing Address - Street 1:235C ROUTE 31
Mailing Address - Street 2:
Mailing Address - City:MACEDON
Mailing Address - State:NY
Mailing Address - Zip Code:14502-9150
Mailing Address - Country:US
Mailing Address - Phone:315-310-5538
Mailing Address - Fax:
Practice Address - Street 1:235C ROUTE 31
Practice Address - Street 2:
Practice Address - City:MACEDON
Practice Address - State:NY
Practice Address - Zip Code:14502-9150
Practice Address - Country:US
Practice Address - Phone:315-310-5538
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-16
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004574171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty