Provider Demographics
NPI:1982174009
Name:PINHASOV, LIRAN (LAC)
Entity Type:Individual
Prefix:
First Name:LIRAN
Middle Name:
Last Name:PINHASOV
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 1:22469 KINGSBURY AVE APT A
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-3626
Mailing Address - Country:US
Mailing Address - Phone:917-656-9789
Mailing Address - Fax:
Practice Address - Street 1:22469 KINGSBURY AVE APT A
Practice Address - Street 2:
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-3626
Practice Address - Country:US
Practice Address - Phone:917-656-9789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-01
Last Update Date:2018-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006439171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty