Provider Demographics
NPI:1952862864
Name:FASCIANI, JOEL (LAC)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:FASCIANI
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 OLD ROUTE 209
Mailing Address - Street 2:HURLEY
Mailing Address - City:APO
Mailing Address - State:AA
Mailing Address - Zip Code:12443
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8 LIVINGSTON ST STE 11
Practice Address - Street 2:
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572-1556
Practice Address - Country:US
Practice Address - Phone:845-876-8994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006301-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY006301-1OtherNY LICENSE
167036OtherNCCAOM