Provider Demographics
NPI:1982036653
Name:FARAKH, YULIYA (LAC)
Entity Type:Individual
Prefix:
First Name:YULIYA
Middle Name:
Last Name:FARAKH
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 1:2 SAMARA CT
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2535
Mailing Address - Country:US
Mailing Address - Phone:516-673-8496
Mailing Address - Fax:
Practice Address - Street 1:2 SAMARA CT
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2535
Practice Address - Country:US
Practice Address - Phone:516-673-8496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004938-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist