Provider Demographics
NPI:1972174639
Name:TEPPER, EMILY BLYTHE (DAC, LAC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:BLYTHE
Last Name:TEPPER
Suffix:
Gender:F
Credentials:DAC, LAC
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:B
Other - Last Name:TEPPER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DAC, LAC
Mailing Address - Street 1:30 SEAMAN AVE APT 1H
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-6309
Mailing Address - Country:US
Mailing Address - Phone:917-573-9069
Mailing Address - Fax:
Practice Address - Street 1:30 SEAMAN AVE APT 1H
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-6309
Practice Address - Country:US
Practice Address - Phone:917-573-9069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-05
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006903171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist