Provider Demographics
NPI:1720404221
Name:TIMIRAS, VERONICA (LAC)
Entity Type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:
Last Name:TIMIRAS
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 1:29 W 57TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-3406
Mailing Address - Country:US
Mailing Address - Phone:917-806-3044
Mailing Address - Fax:
Practice Address - Street 1:29 W 57TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3406
Practice Address - Country:US
Practice Address - Phone:917-806-3044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-09
Last Update Date:2014-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYL.AC 1453171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist