Provider Demographics
NPI:1689018699
Name:BELGRAVE, JANELLE CHRISTINE (LAC)
Entity Type:Individual
Prefix:MISS
First Name:JANELLE
Middle Name:CHRISTINE
Last Name:BELGRAVE
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 1:443 MARCUS GARVEY BLVD
Mailing Address - Street 2:APT 3R
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-2447
Mailing Address - Country:US
Mailing Address - Phone:718-316-2587
Mailing Address - Fax:
Practice Address - Street 1:414 MARCUS GARVEY BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-2420
Practice Address - Country:US
Practice Address - Phone:718-316-2587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-21
Last Update Date:2013-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004996171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist