Provider Demographics
NPI:1730449786
Name:NAUMENKO, KATERINA (MD, LAC)
Entity type:Individual
Prefix:
First Name:KATERINA
Middle Name:
Last Name:NAUMENKO
Suffix:
Gender:F
Credentials:MD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-5431
Mailing Address - Country:US
Mailing Address - Phone:607-275-9697
Mailing Address - Fax:607-697-0153
Practice Address - Street 1:301 W STATE ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5431
Practice Address - Country:US
Practice Address - Phone:607-275-9697
Practice Address - Fax:607-697-0153
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-24
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006598171100000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program