Provider Demographics
NPI:1205539418
Name:TOSIN, IHAR (LAC LMT)
Entity type:Individual
Prefix:
First Name:IHAR
Middle Name:
Last Name:TOSIN
Suffix:
Gender:M
Credentials:LAC LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 AVENUE Z # 2R
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3071
Mailing Address - Country:US
Mailing Address - Phone:718-954-4940
Mailing Address - Fax:
Practice Address - Street 1:2209 AVENUE Z # 2R
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3071
Practice Address - Country:US
Practice Address - Phone:718-954-4940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028584225700000X
NY006938171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty