Provider Demographics
NPI:1043557374
Name:DEICHMAN, JUSTIN B (LAC)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:B
Last Name:DEICHMAN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MARKET ST
Mailing Address - Street 2:SUITE #4
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-2655
Mailing Address - Country:US
Mailing Address - Phone:607-544-4335
Mailing Address - Fax:
Practice Address - Street 1:10 MARKET ST
Practice Address - Street 2:SUITE #4
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-2655
Practice Address - Country:US
Practice Address - Phone:607-544-4335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004214171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist