Provider Demographics
NPI:1982631024
Name:BANEK, VERONICA (DC,LAC,RN)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:BANEK
Suffix:
Gender:F
Credentials:DC,LAC,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-3084
Mailing Address - Country:US
Mailing Address - Phone:631-757-3969
Mailing Address - Fax:631-757-3969
Practice Address - Street 1:17 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-3084
Practice Address - Country:US
Practice Address - Phone:631-757-3969
Practice Address - Fax:631-757-3969
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6912111N00000X
NY603976163W00000X
NY002313171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY113280263OtherTIN
NYX09791Medicare ID - Type Unspecified