Provider Demographics
NPI:1326125394
Name:MIHLE, YAROSLAVA LANA (ACUPUNTURE)
Entity Type:Individual
Prefix:
First Name:YAROSLAVA
Middle Name:LANA
Last Name:MIHLE
Suffix:
Gender:F
Credentials:ACUPUNTURE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 WOOD PL
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-1517
Mailing Address - Country:US
Mailing Address - Phone:631-245-3843
Mailing Address - Fax:631-669-6007
Practice Address - Street 1:382 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-3004
Practice Address - Country:US
Practice Address - Phone:631-669-6221
Practice Address - Fax:631-669-6007
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003169-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist