Provider Demographics
NPI:1245548387
Name:PODHURST, AMY PATER (LAC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:PATER
Last Name:PODHURST
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 1:24 ALDRICH ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-2834
Mailing Address - Country:US
Mailing Address - Phone:516-238-0278
Mailing Address - Fax:
Practice Address - Street 1:24 ALDRICH ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-2834
Practice Address - Country:US
Practice Address - Phone:516-238-0278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-23
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4423171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist