Provider Demographics
NPI:1255511697
Name:ACUPUNCTURE SERVICES OF RANDOLPH,, INC.
Entity type:Organization
Organization Name:ACUPUNCTURE SERVICES OF RANDOLPH,, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DELLEA
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:781-963-0457
Mailing Address - Street 1:171 ROUTE 6A
Mailing Address - Street 2:OLD KINGS. HIGHWAY
Mailing Address - City:SANDWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02563
Mailing Address - Country:US
Mailing Address - Phone:508-833-8567
Mailing Address - Fax:
Practice Address - Street 1:171 ROUTE 6A
Practice Address - Street 2:OLD KINGS. HIGHWAY
Practice Address - City:SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02563
Practice Address - Country:US
Practice Address - Phone:781-963-0457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA219605171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty