Provider Demographics
NPI:1457709214
Name:FAYNGERSH, VITALIY (LAC)
Entity Type:Individual
Prefix:
First Name:VITALIY
Middle Name:
Last Name:FAYNGERSH
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 VALLEY GREENS DR
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-3635
Mailing Address - Country:US
Mailing Address - Phone:516-996-7103
Mailing Address - Fax:
Practice Address - Street 1:58 VALLEY GREENS DR
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-3635
Practice Address - Country:US
Practice Address - Phone:516-996-7103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-01
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00002754171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist