Provider Demographics
NPI:1922373588
Name:DODO, CODY (MS LAC)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:DODO
Suffix:
Gender:M
Credentials:MS LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 4TH AVE
Mailing Address - Street 2:#8J
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4881
Mailing Address - Country:US
Mailing Address - Phone:646-220-1996
Mailing Address - Fax:
Practice Address - Street 1:500 4TH AVE
Practice Address - Street 2:#8J
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4881
Practice Address - Country:US
Practice Address - Phone:646-220-1996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004565171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist