Provider Demographics
NPI:1992829055
Name:NUDELMAN, JEFFREY CRAIG (LAC , LMT)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:CRAIG
Last Name:NUDELMAN
Suffix:
Gender:M
Credentials:LAC , LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 BAYSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-2922
Mailing Address - Country:US
Mailing Address - Phone:516-359-8814
Mailing Address - Fax:516-536-5620
Practice Address - Street 1:156 LONG BEACH RD
Practice Address - Street 2:
Practice Address - City:ISLAND PARK
Practice Address - State:NY
Practice Address - Zip Code:11558-1512
Practice Address - Country:US
Practice Address - Phone:515-359-8814
Practice Address - Fax:516-536-5620
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002454171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist