Healthcare Provider Details

I. General information

NPI: 1750554580
Provider Name (Legal Business Name): ALEXANDER KUZMINOV L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 04/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 BROOK RUN LN
STAMFORD CT
06905-3001
US

IV. Provider business mailing address

52 BROOK RUN LN
STAMFORD CT
06905-3001
US

V. Phone/Fax

Practice location:
  • Phone: 203-461-8463
  • Fax: 203-461-8463
Mailing address:
  • Phone: 203-461-8463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number001144
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number000118
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: