Individual
OLGA IVASHKOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.AC.
Contact information
Practice address
6 PHEASANT RUN, OLD TAPPAN, NJ 07675-7476
(201) 725-1182
Mailing address
6 PHEASANT RUN, OLD TAPPAN, NJ 07675-7476
(201) 725-1182
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
004126
NY
Other
Enumeration date
03/05/2015
Last updated
03/05/2015
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