Provider Demographics
NPI:1083823348
Name:LYANGUZOVA, OLGA X (ACCUPUNCTURE)
Entity Type:Individual
Prefix:MRS
First Name:OLGA
Middle Name:
Last Name:LYANGUZOVA
Suffix:X
Gender:F
Credentials:ACCUPUNCTURE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 FAIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:NJ
Mailing Address - Zip Code:07452-3608
Mailing Address - Country:US
Mailing Address - Phone:201-321-7039
Mailing Address - Fax:201-791-2669
Practice Address - Street 1:26-07 BROADWAY
Practice Address - Street 2:SUIT 23
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-3832
Practice Address - Country:US
Practice Address - Phone:201-321-7039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00026200171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MZ00026200OtherLICENSE