Provider Demographics
NPI:1114341849
Name:NAAYEM, LAITH ANTON (LAC)
Entity Type:Individual
Prefix:MR
First Name:LAITH
Middle Name:ANTON
Last Name:NAAYEM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 DEER RUN RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-8919
Mailing Address - Country:US
Mailing Address - Phone:618-504-0004
Mailing Address - Fax:
Practice Address - Street 1:20 DEER RUN RD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-8919
Practice Address - Country:US
Practice Address - Phone:618-504-0004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005269171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist