Provider Demographics
NPI:1699978692
Name:BAKAMJIAN, NAN (MS, LAC)
Entity type:Individual
Prefix:
First Name:NAN
Middle Name:
Last Name:BAKAMJIAN
Suffix:
Gender:F
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-4042
Mailing Address - Country:US
Mailing Address - Phone:516-767-9337
Mailing Address - Fax:516-767-9337
Practice Address - Street 1:20 VANDERVENTER AVE
Practice Address - Street 2:SUITE 102-W
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-3752
Practice Address - Country:US
Practice Address - Phone:516-767-9337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001860171100000X
CACA6039171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist