Organization
SPIRIT GATE ACUPUNCTURE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUZANNE CLEGG R.D., L.AC. (PRESIDENT)
(516) 823-2511
Entity
Organization
Contact information
Practice address
85 WALNUT ST, LYNBROOK, NY 11563-2139
(516) 823-2511
Mailing address
85 WALNUT ST, LYNBROOK, NY 11563-2139
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
—
—
171100000X
Acupuncturist
Primary
000240
NY
Other
Enumeration date
08/19/2015
Last updated
08/19/2015
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