Healthcare Provider Details

I. General information

NPI: 1255766283
Provider Name (Legal Business Name): LYNN VEIN CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2013
Last Update Date: 09/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 BROAD ST
LYNN MA
01901-1629
US

IV. Provider business mailing address

121 BROAD ST
LYNN MA
01901-1629
US

V. Phone/Fax

Practice location:
  • Phone: 847-593-8460
  • Fax: 224-246-8042
Mailing address:
  • Phone: 847-593-8460
  • Fax: 224-246-8042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. YAN KATSNELSON
Title or Position: OWNER
Credential: M.D.
Phone: 847-593-8460