Provider Demographics
NPI:1144550179
Name:CLASSICAL FIVE-ELEMENT ACUPUNCTURE
Entity type:Organization
Organization Name:CLASSICAL FIVE-ELEMENT ACUPUNCTURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:TERESE
Authorized Official - Last Name:MACCHIAVELLI
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:585-242-9518
Mailing Address - Street 1:3200 BRIGHTON HENRIETTA TL RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-2754
Mailing Address - Country:US
Mailing Address - Phone:585-242-9518
Mailing Address - Fax:585-242-9073
Practice Address - Street 1:3200 BRIGHTON HENRIETTA TL RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-2754
Practice Address - Country:US
Practice Address - Phone:585-242-9518
Practice Address - Fax:585-242-9073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001159-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty