Provider Demographics
NPI:1225369457
Name:NEMIROVSKY, KATHRYN R (LAC)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:R
Last Name:NEMIROVSKY
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 1:22 STUYVESANT ST APT 3
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-4110
Mailing Address - Country:US
Mailing Address - Phone:631-742-3996
Mailing Address - Fax:
Practice Address - Street 1:2568A RIVA RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7445
Practice Address - Country:US
Practice Address - Phone:410-224-2328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-28
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004143171100000X
MDU02044171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist