Blvd Skin Clinic

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

004720 Issued in NY

Legal business name

BLVD SKIN CLINIC

Practice address

8635 Queens Blvd
1-A
Elmhurst, NY 11373-4434

Phone

(917) 943-3682

NPI assigned

Nov 20, 2012

Organization subpart

No

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

Authorized official

Name

Tracey De Costa Byer, L.AC.

Title

Acupuncturist

Phone

(917) 943-3682

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1353369600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1353369600000",
    "number": "1386988921",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8635 QUEENS BLVD",
            "address_2": "1-A",
            "city": "ELMHURST",
            "state": "NY",
            "postal_code": "113734434",
            "telephone_number": "917-943-3682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8635 QUEENS BLVD",
            "address_2": "1-A",
            "city": "ELMHURST",
            "state": "NY",
            "postal_code": "113734434",
            "telephone_number": "917-943-3682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLVD SKIN CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-20",
        "last_updated": "2012-11-20",
        "status": "A",
        "authorized_official_last_name": "DE COSTA BYER",
        "authorized_official_first_name": "TRACEY",
        "authorized_official_title_or_position": "ACUPUNCTURIST",
        "authorized_official_telephone_number": "917-943-3682",
        "authorized_official_credential": "L.AC."
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Acupuncturist",
            "state": "NY",
            "license": "004720",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2012; 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.