Provider Demographics
NPI:1548696966
Name:FLANNERY, BETHANY LEDDY (L AC, MSOM)
Entity type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:LEDDY
Last Name:FLANNERY
Suffix:
Gender:F
Credentials:L AC, MSOM
Other - Prefix:MRS
Other - First Name:BETHANY
Other - Middle Name:MARIE
Other - Last Name:LEDDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:L AC, MSOM
Mailing Address - Street 1:24 E 12TH ST
Mailing Address - Street 2:ROOM 502
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4513
Mailing Address - Country:US
Mailing Address - Phone:646-872-1181
Mailing Address - Fax:
Practice Address - Street 1:24 E 12TH ST
Practice Address - Street 2:ROOM 502
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4513
Practice Address - Country:US
Practice Address - Phone:646-872-1181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002322171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist