Provider Demographics
NPI:1114549466
Name:DE FEO, DARRIN L (LAC)
Entity Type:Individual
Prefix:
First Name:DARRIN
Middle Name:L
Last Name:DE FEO
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 1:142 NEWTON ST APT 3L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-4927
Mailing Address - Country:US
Mailing Address - Phone:718-599-6508
Mailing Address - Fax:
Practice Address - Street 1:1069 BEDFORD AVE FRNT
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-4793
Practice Address - Country:US
Practice Address - Phone:862-252-1230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-09
Last Update Date:2020-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006758171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY006758OtherNYS ACUPUNCTURE LICENSE