Provider Demographics
NPI:1790298156
Name:SHARON, ADAM (LAC)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:
Last Name:SHARON
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 GEDNEY ST APT 1H
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-2215
Mailing Address - Country:US
Mailing Address - Phone:347-989-5196
Mailing Address - Fax:
Practice Address - Street 1:236 KINGS FERRY RD
Practice Address - Street 2:
Practice Address - City:VERPLANCK
Practice Address - State:NY
Practice Address - Zip Code:10596-7701
Practice Address - Country:US
Practice Address - Phone:347-989-5196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-08
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004045171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist