Individual
JED A MICHAEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
422 TAYLOR PL, ITHACA, NY 14850-3137
(215) 880-1951
Mailing address
PO BOX 595, INTERLAKEN, NY 14847-0595
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
AK001171
PA
Other
Enumeration date
10/01/2018
Last updated
10/01/2018
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