Provider Demographics
NPI:1740618842
Name:YURKOSKY, SAMANTHA (LAC)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:
Last Name:YURKOSKY
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 1:205 E 16TH ST
Mailing Address - Street 2:M2A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3746
Mailing Address - Country:US
Mailing Address - Phone:646-221-6535
Mailing Address - Fax:
Practice Address - Street 1:205 E 16TH ST
Practice Address - Street 2:M2A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3746
Practice Address - Country:US
Practice Address - Phone:646-221-6535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005106171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist