Provider Demographics
NPI:1902075351
Name:ANDERSON, BELINDA JANE (PHD LAC)
Entity Type:Individual
Prefix:DR
First Name:BELINDA
Middle Name:JANE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PHD LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 W 22ND ST
Mailing Address - Street 2:APT 2E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-2709
Mailing Address - Country:US
Mailing Address - Phone:617-512-7614
Mailing Address - Fax:
Practice Address - Street 1:PACIFIC COLLEGE OF ORIENTAL MEDICINE
Practice Address - Street 2:915 BROADWAY, 2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-7180
Practice Address - Country:US
Practice Address - Phone:617-512-7614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-29
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA221010171100000X
NY003347171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist