Provider Demographics
NPI:1285817668
Name:SHIAH, ELIZABETH (LAC)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:SHIAH
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 1:635 PARK AVE
Mailing Address - Street 2:8TH FL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6546
Mailing Address - Country:US
Mailing Address - Phone:646-369-6867
Mailing Address - Fax:
Practice Address - Street 1:57 W 57TH ST
Practice Address - Street 2:1109
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2802
Practice Address - Country:US
Practice Address - Phone:212-319-5757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-09
Last Update Date:2007-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25 003181171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist