Provider Demographics
NPI:1942524566
Name:BEAR, AUTUMN (LAC)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:
Last Name:BEAR
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 1:315 MADISON AVE
Mailing Address - Street 2:SUITE 511
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-5405
Mailing Address - Country:US
Mailing Address - Phone:212-883-8700
Mailing Address - Fax:212-887-8301
Practice Address - Street 1:315 MADISON AVE
Practice Address - Street 2:SUITE 511
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-5405
Practice Address - Country:US
Practice Address - Phone:212-883-8700
Practice Address - Fax:212-887-8301
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0042741171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist