Provider Demographics
NPI:1710605639
Name:DEFIEUX, EVERETT JAMES (LAC, LMT)
Entity Type:Individual
Prefix:
First Name:EVERETT
Middle Name:JAMES
Last Name:DEFIEUX
Suffix:
Gender:M
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 SAINT MARKS AVE APT 4H
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-1446
Mailing Address - Country:US
Mailing Address - Phone:215-262-1120
Mailing Address - Fax:
Practice Address - Street 1:103 N 10TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11249-2014
Practice Address - Country:US
Practice Address - Phone:929-489-2284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist