Provider Demographics
NPI:1073837415
Name:ANAYA, MARISA (LAC)
Entity Type:Individual
Prefix:MS
First Name:MARISA
Middle Name:
Last Name:ANAYA
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 1:343 4TH AVE APT 10G
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-2723
Mailing Address - Country:US
Mailing Address - Phone:917-545-7371
Mailing Address - Fax:
Practice Address - Street 1:900 BROADWAY STE 404
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-1239
Practice Address - Country:US
Practice Address - Phone:917-545-7371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-14
Last Update Date:2010-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4273171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist