Provider Demographics
NPI:1275041550
Name:KAY, MICHAEL R (LAC, MSTOM)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:KAY
Suffix:
Gender:M
Credentials:LAC, MSTOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-2519
Mailing Address - Country:US
Mailing Address - Phone:718-302-2123
Mailing Address - Fax:
Practice Address - Street 1:67 OLIVE ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-2519
Practice Address - Country:US
Practice Address - Phone:718-302-2123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006170171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist