Provider Demographics
NPI:1891387924
Name:FALCO, JODI A
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:A
Last Name:FALCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 WALT WHITMAN RD APT 27A
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-2825
Mailing Address - Country:US
Mailing Address - Phone:516-455-6764
Mailing Address - Fax:
Practice Address - Street 1:1135 WALT WHITMAN RD APT 27A
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-2825
Practice Address - Country:US
Practice Address - Phone:516-455-6764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021809-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist