Provider Demographics
NPI:1033620356
Name:TIMBERLAKE, RACHAEL (LAC)
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:TIMBERLAKE
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 1:221 E 18TH ST APT 6J
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-4732
Mailing Address - Country:US
Mailing Address - Phone:917-214-7123
Mailing Address - Fax:
Practice Address - Street 1:20 W 20TH ST STE 1002
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-9252
Practice Address - Country:US
Practice Address - Phone:917-214-7123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-13
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002549171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist