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General NPI Number Information
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NPI Number | 1205950367
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Entity Type | Individual
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Provider Name | EDWARD IZRAILOV L.AC.
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Gender | Male
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 06/13/2011
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Provider Practice Location Address
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Address Line | 1861 SPRINGFIELD AVE
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City | MAPLEWOOD
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State | NJ
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Zip | 07040-2954
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Country | US
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Telephone | 973-303-0758
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Fax |
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Provider Business Mailing Address
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Address Line | 23 N RIDGE RD
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City | LIVINGSTON
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State | NJ
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Zip | 07039-1238
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Country | US
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Telephone | 973-303-0758
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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 | 25MZ00050400
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 003234-1
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License Number State | NY
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