Provider Demographics
NPI:1932441649
Name:GAMARNIK, LARISA
Entity Type:Individual
Prefix:
First Name:LARISA
Middle Name:
Last Name:GAMARNIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 83RD ST
Mailing Address - Street 2:APT 5G
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-2661
Mailing Address - Country:US
Mailing Address - Phone:347-241-0107
Mailing Address - Fax:
Practice Address - Street 1:2250 83 STREET
Practice Address - Street 2:APT 5G
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214
Practice Address - Country:US
Practice Address - Phone:347-241-0107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2527698174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist