Provider Demographics
NPI:1093140485
Name:JAGUSIAK, CHRISTINA (LAC)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:
Last Name:JAGUSIAK
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 1:9728 3RD AVE
Mailing Address - Street 2:UNIT #345
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-7742
Mailing Address - Country:US
Mailing Address - Phone:917-392-1340
Mailing Address - Fax:
Practice Address - Street 1:9728 3RD AVE
Practice Address - Street 2:UNIT #345
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-7742
Practice Address - Country:US
Practice Address - Phone:917-392-1340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005109-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist