Provider Demographics
NPI:1669710463
Name:O'CONNOR, MARJORIE RUTH (LAC)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:RUTH
Last Name:O'CONNOR
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 1:223 SEA CLIFF AVE
Mailing Address - Street 2:
Mailing Address - City:SEA CLIFF
Mailing Address - State:NY
Mailing Address - Zip Code:11579-1231
Mailing Address - Country:US
Mailing Address - Phone:516-353-9376
Mailing Address - Fax:
Practice Address - Street 1:223 SEA CLIFF AVE
Practice Address - Street 2:
Practice Address - City:SEA CLIFF
Practice Address - State:NY
Practice Address - Zip Code:11579-1231
Practice Address - Country:US
Practice Address - Phone:516-353-9376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004473171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist