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General NPI Number Information
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NPI Number | 1194368142
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Entity Type | Individual
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Provider Name | IGOR SHKAPENYUK LAC
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Gender | Male
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Dates
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Enumeration Date | 10/22/2019
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Last Update Date | 10/22/2019
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Provider Practice Location Address
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Address Line | 55 GREENE AVE STE LLB
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City | BROOKLYN
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State | NY
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Zip | 11238-6432
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Country | US
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Telephone | 718-398-7777
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Fax |
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Provider Business Mailing Address
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Address Line | 1755 OCEAN PKWY APT E18
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City | BROOKLYN
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State | NY
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Zip | 11223-2030
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Country | US
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Telephone | 646-472-9319
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 002675
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License Number State | NY
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