Provider Demographics
NPI:1518163138
Name:FELDMAN, LARA IVY (LAC)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:IVY
Last Name:FELDMAN
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 1:220 WATER ST
Mailing Address - Street 2:#3
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-1158
Mailing Address - Country:US
Mailing Address - Phone:917-974-7977
Mailing Address - Fax:
Practice Address - Street 1:220 WATER ST
Practice Address - Street 2:#3
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-1158
Practice Address - Country:US
Practice Address - Phone:917-974-7977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002598171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist