Provider Demographics
NPI:1487055364
Name:DWECK, EMMA KISSLINGER (MAC, LAC)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:KISSLINGER
Last Name:DWECK
Suffix:
Gender:F
Credentials:MAC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3712 ROUTE 44
Mailing Address - Street 2:
Mailing Address - City:MILLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:12545-5100
Mailing Address - Country:US
Mailing Address - Phone:845-605-2707
Mailing Address - Fax:
Practice Address - Street 1:3712 ROUTE 44
Practice Address - Street 2:
Practice Address - City:MILLBROOK
Practice Address - State:NY
Practice Address - Zip Code:12545-5100
Practice Address - Country:US
Practice Address - Phone:845-605-2707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005390171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist