Provider Demographics
NPI:1093885865
Name:VARTOLO, VANESSA (LAC)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:VARTOLO
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 1:1032 84TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-2926
Mailing Address - Country:US
Mailing Address - Phone:917-697-3536
Mailing Address - Fax:718-876-6143
Practice Address - Street 1:6931 3RD AVE FL 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-1304
Practice Address - Country:US
Practice Address - Phone:917-697-3536
Practice Address - Fax:718-876-6143
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002343-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist