Provider Demographics
NPI:1629206412
Name:ALICEA, KEVIN (LAC)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:ALICEA
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 1:420 MADISON AVE
Mailing Address - Street 2:SUITE 803
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-1107
Mailing Address - Country:US
Mailing Address - Phone:212-319-0485
Mailing Address - Fax:212-319-0435
Practice Address - Street 1:420 MADISON AVE
Practice Address - Street 2:SUITE 803
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-1107
Practice Address - Country:US
Practice Address - Phone:212-319-0485
Practice Address - Fax:212-319-0435
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1945171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist