Provider Demographics
NPI:1619520012
Name:IACOBELLIS, MICHAEL (DIPLAC, LAC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:IACOBELLIS
Suffix:
Gender:M
Credentials:DIPLAC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 OLD COUNTRY RD STE C
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-4933
Mailing Address - Country:US
Mailing Address - Phone:516-719-8585
Mailing Address - Fax:516-719-8586
Practice Address - Street 1:641 OLD COUNTRY RD STE C
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4933
Practice Address - Country:US
Practice Address - Phone:516-719-8585
Practice Address - Fax:516-719-8586
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003168-01171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist