Provider Demographics
NPI:1174880868
Name:MEKHANIK, PAVEL (LAC)
Entity type:Individual
Prefix:MR
First Name:PAVEL
Middle Name:
Last Name:MEKHANIK
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 E 13TH ST APT 5D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4439
Mailing Address - Country:US
Mailing Address - Phone:646-441-8871
Mailing Address - Fax:718-294-6060
Practice Address - Street 1:2611 E 13TH ST APT 5D
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-4439
Practice Address - Country:US
Practice Address - Phone:646-441-8871
Practice Address - Fax:718-294-6060
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004319171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist