Provider Demographics
NPI:1629325188
Name:ALVAREZ, JOAO MANUEL (LAC)
Entity Type:Individual
Prefix:
First Name:JOAO
Middle Name:MANUEL
Last Name:ALVAREZ
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 1:10 PAULDING ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-1960
Mailing Address - Country:US
Mailing Address - Phone:631-697-0945
Mailing Address - Fax:
Practice Address - Street 1:117 MAIN ST
Practice Address - Street 2:
Practice Address - City:COLD SPRING HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11724-1424
Practice Address - Country:US
Practice Address - Phone:631-697-0945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003400171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist