Provider Demographics
NPI:1568822419
Name:BARTOLINI, JESSICA (LAC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BARTOLINI
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 1:10339 DARIEN RD
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14080-9628
Mailing Address - Country:US
Mailing Address - Phone:716-989-7886
Mailing Address - Fax:
Practice Address - Street 1:21 S GROVE ST
Practice Address - Street 2:
Practice Address - City:EAST AURORA
Practice Address - State:NY
Practice Address - Zip Code:14052-2345
Practice Address - Country:US
Practice Address - Phone:716-989-7886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004933-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist