Provider Demographics
NPI:1679855563
Name:VAN DINA, MEGHAN (LAC)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:VAN DINA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 NORTHERN BLVD
Mailing Address - Street 2:STE 307
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-4311
Mailing Address - Country:US
Mailing Address - Phone:516-384-7452
Mailing Address - Fax:
Practice Address - Street 1:107 NORTHERN BLVD
Practice Address - Street 2:STE 307
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4311
Practice Address - Country:US
Practice Address - Phone:516-384-7452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004171171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist