Provider Demographics
NPI:1407041460
Name:LOCASCIO, MARTIN PETER (LAC)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:PETER
Last Name:LOCASCIO
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 1:35 CANDLEWOOD PATH
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5305
Mailing Address - Country:US
Mailing Address - Phone:631-492-0158
Mailing Address - Fax:631-499-3536
Practice Address - Street 1:555 ISLIP AVE
Practice Address - Street 2:
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-1501
Practice Address - Country:US
Practice Address - Phone:631-492-0158
Practice Address - Fax:631-499-3536
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001085171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist