Provider Demographics
NPI:1760662670
Name:SIRIANNI, ROBERT JR (MS, LAC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:SIRIANNI
Suffix:JR
Gender:M
Credentials:MS, LAC
Other - Prefix:
Other - First Name:BOB
Other - Middle Name:
Other - Last Name:SIRIANNI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, LAC
Mailing Address - Street 1:511 W 169TH ST
Mailing Address - Street 2:SUITE 41
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-4015
Mailing Address - Country:US
Mailing Address - Phone:917-679-1793
Mailing Address - Fax:
Practice Address - Street 1:39 W 14TH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7489
Practice Address - Country:US
Practice Address - Phone:917-679-1793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003608171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist