Provider Demographics
NPI:1629415344
Name:MOSTEK, MATEUSZ MACIEJ (LAC)
Entity Type:Individual
Prefix:MR
First Name:MATEUSZ
Middle Name:MACIEJ
Last Name:MOSTEK
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2274 LYON AVENUE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462
Mailing Address - Country:US
Mailing Address - Phone:631-742-0693
Mailing Address - Fax:718-684-3055
Practice Address - Street 1:2510 WESTCHESTER AVENUE
Practice Address - Street 2:110
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461
Practice Address - Country:US
Practice Address - Phone:718-684-3050
Practice Address - Fax:718-684-3055
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5049171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist