Provider Demographics
NPI:1467099861
Name:MAYZENBERG, IGOR (ACUPUNCTURIST)
Entity Type:Individual
Prefix:
First Name:IGOR
Middle Name:
Last Name:MAYZENBERG
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 W 10TH ST APT B2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-1152
Mailing Address - Country:US
Mailing Address - Phone:718-837-5361
Mailing Address - Fax:718-256-5359
Practice Address - Street 1:2166 79TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-1909
Practice Address - Country:US
Practice Address - Phone:718-837-5361
Practice Address - Fax:718-256-5359
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000408171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist