Individual
MR. JUSTIN WILFRED DOUGHERTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.AC
Contact information
Practice address
516 LAKEVILLE RD, NEW HYDE PARK, NY 11040-3006
(516) 993-1416
Mailing address
PO BOX 769, NEW HYDE PARK, NY 11040-0769
(516) 993-1416
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
25005672
NY
Other
Enumeration date
11/11/2015
Last updated
07/08/2016
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