Provider Demographics
NPI:1518733054
Name:HANCA-ILLA, JOANNA DANUTA (LAC)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:DANUTA
Last Name:HANCA-ILLA
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 1:2 LIAM DR APT 413
Mailing Address - Street 2:
Mailing Address - City:BEACON
Mailing Address - State:NY
Mailing Address - Zip Code:12508-2248
Mailing Address - Country:US
Mailing Address - Phone:646-392-6378
Mailing Address - Fax:
Practice Address - Street 1:33 HENRY ST
Practice Address - Street 2:
Practice Address - City:BEACON
Practice Address - State:NY
Practice Address - Zip Code:12508-3006
Practice Address - Country:US
Practice Address - Phone:646-392-6378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007345171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist