Jacquelyn R Riddick, LAC.

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

005208-1 Issued in NY

Practice address

394 Hasbrouck Ave.
Kingston, NY 12401

Phone

(845) 750-4896

NPI assigned

Apr 14, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other names 1

• Ms. Jacquelyn R McDonald Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Eagle Peak Wellness, Inc.

  • Clinic/Center
  • Kingston, NY
  • NPI 1396411690
  NPD Authorized official

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

{
    "created_epoch": "1397433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694563200000",
    "number": "1184043572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "394 HASBROUCK AVE #2C",
            "city": "KINGSTON",
            "state": "NY",
            "postal_code": "12401",
            "telephone_number": "845-750-4896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "394 HASBROUCK AVE.",
            "city": "KINGSTON",
            "state": "NY",
            "postal_code": "12401",
            "telephone_number": "845-750-4896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIDDICK",
        "first_name": "JACQUELYN",
        "middle_name": "R",
        "name_prefix": "Ms.",
        "credential": "LAC.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-04-14",
        "last_updated": "2023-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "NY",
            "license": "25 005208",
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": "NY",
            "license": "019298-1",
            "primary": false
        },
        {
            "code": "171100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Acupuncturist",
            "state": "NY",
            "license": "005208-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELYN",
            "last_name": "MCDONALD",
            "middle_name": "R",
            "prefix": "MS.",
            "credential": "LAC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Richard W. Moscowitz, M.D., P.a., P.C.
• Jennifer A Richards, ORTON-GILLINGHAM
• Keenan Robert Richards, M.D.
• Patricia Riche, COTA/L
• Stephanie Richers, LCSW
• Christina Rider, LPN
• Mary E Rider, RN
• Megan Riebesell
• Rite Aid of New York Inc
• Diane Ritters

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2023; 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.