Provider Demographics
NPI:1013569615
Name:LOMINY, JADE ELIZABETH (LAC)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:ELIZABETH
Last Name:LOMINY
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:PO BOX 176
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-0176
Mailing Address - Country:US
Mailing Address - Phone:347-358-7503
Mailing Address - Fax:
Practice Address - Street 1:3 MEADOWRUE LN
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-2607
Practice Address - Country:US
Practice Address - Phone:347-358-7503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-12
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006553-01171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist