Provider Demographics
NPI:1548596901
Name:SEMBELLO, DOMINIC (LAC)
Entity Type:Individual
Prefix:
First Name:DOMINIC
Middle Name:
Last Name:SEMBELLO
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 1:929 SANDY CIR
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-2551
Mailing Address - Country:US
Mailing Address - Phone:609-597-2988
Mailing Address - Fax:
Practice Address - Street 1:401 NEW RD STE 210
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1200
Practice Address - Country:US
Practice Address - Phone:609-248-6922
Practice Address - Fax:609-601-0041
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-20
Last Update Date:2020-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK000688171100000X
NJ25MZ00039300171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist