Provider Demographics
NPI:1033824933
Name:KAZAKOS RESH, THALIA (LAC)
Entity Type:Individual
Prefix:MS
First Name:THALIA
Middle Name:
Last Name:KAZAKOS RESH
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 1:928 BROADWAY STE 604
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-8140
Mailing Address - Country:US
Mailing Address - Phone:413-325-6690
Mailing Address - Fax:
Practice Address - Street 1:928 BROADWAY STE 604
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-8140
Practice Address - Country:US
Practice Address - Phone:413-325-6690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-16
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007231-01171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist