Provider Demographics
NPI:1568019065
Name:SPECIALE, JOIA MARIE (LAC)
Entity Type:Individual
Prefix:
First Name:JOIA
Middle Name:MARIE
Last Name:SPECIALE
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 1:2665 MAIN ST APT 1A
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-1030
Mailing Address - Country:US
Mailing Address - Phone:917-696-2586
Mailing Address - Fax:
Practice Address - Street 1:66 LAWRENCEVILLE PENNINGTON RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-1666
Practice Address - Country:US
Practice Address - Phone:609-896-0560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00140500171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist