Individual
KEVIN GORDON COLEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.AC.
Contact information
Practice address
38 LANDING AVE, SMITHTOWN, NY 11787-2711
(631) 457-9523
Mailing address
40 W BROADWAY, PORT JEFFERSON STATION, NY 11776-3837
(631) 457-9523
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
005047-1
NY
Other
Enumeration date
05/29/2013
Last updated
05/29/2013
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