1275632150 NPI number — MS. LANA M. ACKAWAY NYS LICENSED CLINICA

Table of content: MS. LANA M. ACKAWAY NYS LICENSED CLINICA (NPI 1275632150)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275632150 NPI number — MS. LANA M. ACKAWAY NYS LICENSED CLINICA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ACKAWAY
Provider First Name:
LANA
Provider Middle Name:
M.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
NYS LICENSED CLINICA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ACKAWAY
Provider Other First Name:
LANA
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CERTIFIED PSYCHOANAL
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1275632150
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
241 EAST 38TH ST.
Provider Second Line Business Mailing Address:
SUITE 2A
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10016-2787
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-294-7883
Provider Business Mailing Address Fax Number:
212-953-6902

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
280 MADISON AVE
Provider Second Line Business Practice Location Address:
SUITE 608
Provider Business Practice Location Address City Name:
NY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10016-2787
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-294-7883
Provider Business Practice Location Address Fax Number:
212-953-6902
Provider Enumeration Date:
09/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  R0291471 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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