1609284967 NPI number — BL HEALTHY LIFE ACUPUNCTURE P.C.

Table of content: MADALYN MARIE LUTZ DO (NPI 1699394551)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609284967 NPI number — BL HEALTHY LIFE ACUPUNCTURE P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BL HEALTHY LIFE ACUPUNCTURE P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609284967
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
134 BEACH 98TH STREET
Provider Second Line Business Mailing Address:
ROCKAWAY PARK
Provider Business Mailing Address City Name:
QUEENS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11694-2851
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-945-6076
Provider Business Mailing Address Fax Number:
718-945-6076

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
134 BEACH 98TH STREET, SUITE 1
Provider Second Line Business Practice Location Address:
ROCKAWAY PARK
Provider Business Practice Location Address City Name:
QUEENS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11694-2851
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-945-6076
Provider Business Practice Location Address Fax Number:
718-945-6076
Provider Enumeration Date:
07/30/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BOBCHYNSKA
Authorized Official First Name:
LUDMILA
Authorized Official Middle Name:
Authorized Official Title or Position:
ACUPUNCTURIST
Authorized Official Telephone Number:
917-561-2168

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  002381 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)