Provider Demographics
NPI:1982884151
Name:PULSIFER, JEREMY VARNUM (MSTOM, LAC)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:VARNUM
Last Name:PULSIFER
Suffix:
Gender:M
Credentials:MSTOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3618 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-1939
Mailing Address - Country:US
Mailing Address - Phone:347-665-7699
Mailing Address - Fax:
Practice Address - Street 1:30 E 20TH ST
Practice Address - Street 2:SUITE 5RW
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-1310
Practice Address - Country:US
Practice Address - Phone:347-665-7699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25-003224171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist