Provider Demographics
NPI:1497370084
Name:DISAKIAS, ASPASIA SUE (LAC)
Entity Type:Individual
Prefix:
First Name:ASPASIA
Middle Name:SUE
Last Name:DISAKIAS
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 1:389 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:OAKHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07755-1271
Mailing Address - Country:US
Mailing Address - Phone:732-856-1455
Mailing Address - Fax:
Practice Address - Street 1:55-77 SCHANCK RD STE B-17
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2964
Practice Address - Country:US
Practice Address - Phone:732-414-6060
Practice Address - Fax:732-414-6061
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJDCATEMP-022286171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist