Healthcare Provider Details

I. General information

NPI: 1649674482
Provider Name (Legal Business Name): SARA REZNIKOFF L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2014
Last Update Date: 10/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1085 UNION ST #7
BROOKLYN NY
11225-6504
US

IV. Provider business mailing address

1085 UNION ST #7
BROOKLYN NY
11225-6504
US

V. Phone/Fax

Practice location:
  • Phone: 917-692-5654
  • Fax:
Mailing address:
  • Phone: 917-692-5654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number004485-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: