Healthcare Provider Details

I. General information

NPI: 1174632020
Provider Name (Legal Business Name): MAURICE TOUILI LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 CLARKSON AVENUE G BLDG ADMINISTRATION DEPT PSYCHIATRY
BROOKLYN NY
11203
US

IV. Provider business mailing address

290 9TH AVENUE APT 5F
NEW YORK NY
10001
US

V. Phone/Fax

Practice location:
  • Phone: 718-245-2303
  • Fax:
Mailing address:
  • Phone: 212-414-0918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number001508
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: