Provider Demographics
NPI:1982190872
Name:CUMMINGS, IMANI MARYN (LAC)
Entity Type:Individual
Prefix:
First Name:IMANI
Middle Name:MARYN
Last Name:CUMMINGS
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 1:295 DECATUR ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233-1704
Mailing Address - Country:US
Mailing Address - Phone:917-765-4555
Mailing Address - Fax:
Practice Address - Street 1:295 DECATUR ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233-1704
Practice Address - Country:US
Practice Address - Phone:917-765-4555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY25-005465171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist