Healthcare Provider Details

I. General information

NPI: 1861994063
Provider Name (Legal Business Name): ALEXANDER VAMOS L.AC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2018
Last Update Date: 03/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 COATES AVE
HOLBROOK NY
11741-6039
US

IV. Provider business mailing address

51 JOANNE DR
HOLBROOK NY
11741-5604
US

V. Phone/Fax

Practice location:
  • Phone: 516-982-0912
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number002978
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: