Provider Demographics
NPI:1629548524
Name:GAY, JANNA (LAC)
Entity Type:Individual
Prefix:
First Name:JANNA
Middle Name:
Last Name:GAY
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:PO BOX 125
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18044-0125
Mailing Address - Country:US
Mailing Address - Phone:908-827-1826
Mailing Address - Fax:
Practice Address - Street 1:524 NORTHAMPTON ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-3517
Practice Address - Country:US
Practice Address - Phone:908-827-1826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAK001217171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist