Provider Demographics
NPI:1013622828
Name:ODIERNA, PATRICK B (LAC, LMT)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:B
Last Name:ODIERNA
Suffix:
Gender:M
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 VILLAGE LINE RD
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-1510
Mailing Address - Country:US
Mailing Address - Phone:631-236-2982
Mailing Address - Fax:
Practice Address - Street 1:29 VILLAGE LINE RD
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-1510
Practice Address - Country:US
Practice Address - Phone:631-236-2982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007206171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist