Mark Doherty, LAC, LMT

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

007088 Issued in NY

Practice address

623 Broadway
Massapequa, NY 11758-5027

Phone

(516) 781-1078

NPI assigned

Oct 14, 2019

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Emerge Yoga & Wellness

  • Acupuncturist
  • Massapequa, NY
  • NPI 1417319252
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1571011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645056000000",
    "number": "1144862822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "623 BROADWAY",
            "city": "MASSAPEQUA",
            "state": "NY",
            "postal_code": "117585027",
            "telephone_number": "516-781-1078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "623 BROADWAY",
            "city": "MASSAPEQUA",
            "state": "NY",
            "postal_code": "117585027",
            "telephone_number": "516-781-1078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOHERTY",
        "first_name": "MARK",
        "credential": "LAC, LMT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-10-14",
        "last_updated": "2022-02-17",
        "certification_date": "2022-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "NY",
            "license": "030560",
            "primary": false
        },
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "NY",
            "license": "007088",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Noelle Diraimondo, M.S. ED., NCC
• Jamie Leigh Disilvio
• Lori Distefano, SLP-CCC
• Michael Francis Ditrani, D.D.S.
• Michael Dodick, DPT
• Marilyn Dolce
• Jeffrey Donato
• Madelyn Karmina Donis, MS, OTR/L
• Donna L.Henig, M.D.,P.C.
• Marissa Lynne Donnelly, MOT, OTR/L

• Acupuncturist in Massapequa, NY
• Providers in Massapequa, NY by specialty
• Acupuncturist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.