Provider Demographics
NPI:1023576535
Name:MOLDOVAN, ADINA (LAC)
Entity Type:Individual
Prefix:
First Name:ADINA
Middle Name:
Last Name:MOLDOVAN
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 1:39 HOPE DR
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-5625
Mailing Address - Country:US
Mailing Address - Phone:516-849-8602
Mailing Address - Fax:
Practice Address - Street 1:377 S OYSTER BAY RD UNIT B
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-3321
Practice Address - Country:US
Practice Address - Phone:516-849-8602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006456171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty