Healthcare Provider Details

I. General information

NPI: 1174880868
Provider Name (Legal Business Name): PAVEL MEKHANIK L.AC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2012
Last Update Date: 04/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 E 13TH ST APT 5D
BROOKLYN NY
11235-4439
US

IV. Provider business mailing address

2611 E 13TH ST APT 5D
BROOKLYN NY
11235-4439
US

V. Phone/Fax

Practice location:
  • Phone: 646-441-8871
  • Fax: 718-294-6060
Mailing address:
  • Phone: 646-441-8871
  • Fax: 718-294-6060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number004319
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: