Provider Demographics
NPI:1295082576
Name:CANTOR, ADAM (LAC)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:CANTOR
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 GLEN COVE AVE
Mailing Address - Street 2:SUITE #6
Mailing Address - City:GLEN HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545-1592
Mailing Address - Country:US
Mailing Address - Phone:201-745-1506
Mailing Address - Fax:
Practice Address - Street 1:1009 GLEN COVE AVE
Practice Address - Street 2:SUITE #6
Practice Address - City:GLEN HEAD
Practice Address - State:NY
Practice Address - Zip Code:11545-1592
Practice Address - Country:US
Practice Address - Phone:201-745-1506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004840-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist