Provider Demographics
NPI:1922332758
Name:LESCANO, CARLA
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:
Last Name:LESCANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 WARREN ST
Mailing Address - Street 2:# 439
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-6456
Mailing Address - Country:US
Mailing Address - Phone:551-200-0170
Mailing Address - Fax:
Practice Address - Street 1:19 W 21ST ST
Practice Address - Street 2:SUITE 904
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-6805
Practice Address - Country:US
Practice Address - Phone:551-200-0170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-26
Last Update Date:2009-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004180171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist