Provider Demographics
NPI:1376895797
Name:HOLISTIC FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:HOLISTIC FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMENICK
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MASIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:212-688-4818
Mailing Address - Street 1:430 OLD SIB RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-2335
Mailing Address - Country:US
Mailing Address - Phone:203-826-3582
Mailing Address - Fax:855-798-2816
Practice Address - Street 1:141 E 55TH ST
Practice Address - Street 2:# 10F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4030
Practice Address - Country:US
Practice Address - Phone:203-826-3582
Practice Address - Fax:855-798-2816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-09
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty