Provider Demographics
NPI:1497204374
Name:KRUPNOVA, LYUDMILA (LAC)
Entity Type:Individual
Prefix:
First Name:LYUDMILA
Middle Name:
Last Name:KRUPNOVA
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 1:2621 BROWN ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-1669
Mailing Address - Country:US
Mailing Address - Phone:646-552-2249
Mailing Address - Fax:
Practice Address - Street 1:2621 BROWN ST APT 1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-1669
Practice Address - Country:US
Practice Address - Phone:646-552-2249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004462171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist