Provider Demographics
NPI:1154568905
Name:TSYPIN, GALINA (LAC)
Entity type:Individual
Prefix:
First Name:GALINA
Middle Name:
Last Name:TSYPIN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3174 29TH ST APT 3L
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-3380
Mailing Address - Country:US
Mailing Address - Phone:917-741-0010
Mailing Address - Fax:201-791-7111
Practice Address - Street 1:39-40 BROADWAY
Practice Address - Street 2:SUITE 4
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-5419
Practice Address - Country:US
Practice Address - Phone:201-791-0008
Practice Address - Fax:201-791-7111
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00065500171100000X
NY003704171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist