Provider Demographics
NPI:1619009917
Name:CARBAJAL, JAVIER (LAC)
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:
Last Name:CARBAJAL
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6735 RIDGE BLVD
Mailing Address - Street 2:SUITE # 3K
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-5248
Mailing Address - Country:US
Mailing Address - Phone:917-517-0633
Mailing Address - Fax:
Practice Address - Street 1:304 PARK AVE S
Practice Address - Street 2:6TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4301
Practice Address - Country:US
Practice Address - Phone:646-367-7325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002963-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist