Provider Demographics
NPI:1639756034
Name:LYGDENOVA, ERZHENA
Entity Type:Individual
Prefix:MISS
First Name:ERZHENA
Middle Name:
Last Name:LYGDENOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3060 OCEAN AVE APT 5V
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3355
Mailing Address - Country:US
Mailing Address - Phone:347-466-6031
Mailing Address - Fax:
Practice Address - Street 1:65 BROADWAY STE 902
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-2528
Practice Address - Country:US
Practice Address - Phone:347-466-6031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006831-01171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist