Provider Demographics
NPI:1023445178
Name:BURNS, MAURA ELIZABETH (LAC)
Entity type:Individual
Prefix:
First Name:MAURA
Middle Name:ELIZABETH
Last Name:BURNS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 W 27TH ST
Mailing Address - Street 2:ROOM 206
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6207
Mailing Address - Country:US
Mailing Address - Phone:646-977-4840
Mailing Address - Fax:
Practice Address - Street 1:121 W 27TH ST
Practice Address - Street 2:ROOM 206
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6207
Practice Address - Country:US
Practice Address - Phone:646-977-4840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005081171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist