Provider Demographics
NPI:1912203621
Name:ROJANAVONGSE, VIDHYA (LAC)
Entity Type:Individual
Prefix:MR
First Name:VIDHYA
Middle Name:
Last Name:ROJANAVONGSE
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 1:50 LEXINGTON AVE
Mailing Address - Street 2:SUITE LL3
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-2935
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:50 LEXINGTON AVE
Practice Address - Street 2:SUITE LL3
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-2935
Practice Address - Country:US
Practice Address - Phone:917-650-2801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003063171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist