Provider Demographics
NPI:1144455593
Name:COUNIHAN, KERRY (LAC)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:COUNIHAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9522 63RD RD
Mailing Address - Street 2:SUITE 514
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1142
Mailing Address - Country:US
Mailing Address - Phone:917-750-3693
Mailing Address - Fax:
Practice Address - Street 1:44 E 32ND ST
Practice Address - Street 2:11TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5508
Practice Address - Country:US
Practice Address - Phone:212-685-2848
Practice Address - Fax:212-689-4497
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003427171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist