Provider Demographics
NPI:1528185964
Name:VISELLI, ENRICO (LAC)
Entity Type:Individual
Prefix:MR
First Name:ENRICO
Middle Name:
Last Name:VISELLI
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 1:140 LOCKWOOD AVE
Mailing Address - Street 2:107
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-4915
Mailing Address - Country:US
Mailing Address - Phone:914-632-1896
Mailing Address - Fax:914-632-4284
Practice Address - Street 1:140 LOCKWOOD AVE
Practice Address - Street 2:107
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-4915
Practice Address - Country:US
Practice Address - Phone:914-632-1896
Practice Address - Fax:914-632-4284
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2235-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist