Provider Demographics
NPI:1295237014
Name:SUSANA BYERS, LIC. AC.
Entity type:Organization
Organization Name:SUSANA BYERS, LIC. AC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:SUSANA
Authorized Official - Middle Name:B
Authorized Official - Last Name:BYERS
Authorized Official - Suffix:
Authorized Official - Credentials:LIC AC
Authorized Official - Phone:917-541-6275
Mailing Address - Street 1:30 RESERVATION RD
Mailing Address - Street 2:
Mailing Address - City:EASTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-1227
Mailing Address - Country:US
Mailing Address - Phone:917-541-6275
Mailing Address - Fax:
Practice Address - Street 1:39 MAIN ST STE 34
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3132
Practice Address - Country:US
Practice Address - Phone:917-541-6275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA241597171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1568610202OtherNPI