Provider Demographics
NPI:1558680249
Name:VATELMAN, IGOR (LAC,LMT)
Entity type:Individual
Prefix:MR
First Name:IGOR
Middle Name:
Last Name:VATELMAN
Suffix:
Gender:M
Credentials:LAC,LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 BROAWAY
Mailing Address - Street 2:SUITE 600
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-8137
Mailing Address - Country:US
Mailing Address - Phone:917-853-0343
Mailing Address - Fax:
Practice Address - Street 1:928 BROADWAY STE 600
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-8137
Practice Address - Country:US
Practice Address - Phone:917-853-0343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-20
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004587171100000X
NY023055225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist