Provider Demographics
NPI:1174837249
Name:ASENSI, JEAN PAUL (LAC)
Entity Type:Individual
Prefix:MR
First Name:JEAN
Middle Name:PAUL
Last Name:ASENSI
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 1:5405 DOUGLASTON PKWY
Mailing Address - Street 2:
Mailing Address - City:DOUGLASTON
Mailing Address - State:NY
Mailing Address - Zip Code:11362-1530
Mailing Address - Country:US
Mailing Address - Phone:646-573-4984
Mailing Address - Fax:
Practice Address - Street 1:5405 DOUGLASTON PKWY
Practice Address - Street 2:
Practice Address - City:DOUGLASTON
Practice Address - State:NY
Practice Address - Zip Code:11362-1530
Practice Address - Country:US
Practice Address - Phone:646-573-4984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-01
Last Update Date:2010-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004383-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist