Liran Domachevsky
in Brookline, MA. Individual provider (NPI-1).
NPI number1487909412
StatusActive
Last updated in NPPESJul 16, 2012
Details
- NPI
- 1487909412
- Entity type
- Individual (NPI-1)
- Name
- Liran Domachevsky
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Jul 16, 2012
- Last updated
- Jul 16, 2012
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2085N0904X | 248431 | MA | Yes |
Practice location
375 Boylston StBrookline, MA 02445-6007
Phone 857-307-0849
Mailing address
29 Bartlett Crescent Apt 2Brookline, MA 02446
Phone 617-529-2093
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