Individual
MR. RYDER J. CHAMPOUILLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSOM, L.AC
Contact information
Practice address
166 BERGEN ST, PORT JEFFERSON STATION, NY 11776-1910
(631) 629-5433
Mailing address
166 BERGEN ST, PORT JEFFERSON STATION, NY 11776-1910
(631) 525-2161
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
003573-1
NY
Other
Enumeration date
01/18/2010
Last updated
08/09/2013
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