Provider Demographics
NPI:1538990791
Name:DESRAVINES ACUPUNCTURE PC
Entity type:Organization
Organization Name:DESRAVINES ACUPUNCTURE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEDZDABE
Authorized Official - Middle Name:
Authorized Official - Last Name:DESRAVINES
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:516-794-2200
Mailing Address - Street 1:335 OCEAN PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-4104
Mailing Address - Country:US
Mailing Address - Phone:516-794-2200
Mailing Address - Fax:718-949-1576
Practice Address - Street 1:200 OLD COUNTRY RD STE 140
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4273
Practice Address - Country:US
Practice Address - Phone:516-794-2200
Practice Address - Fax:718-949-1576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty