Provider Demographics
NPI:1184057853
Name:VENTIMIGLIA-FRAHER, ANGELA (LAC)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:VENTIMIGLIA-FRAHER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 WOODLAND LN
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-1542
Mailing Address - Country:US
Mailing Address - Phone:516-809-6923
Mailing Address - Fax:
Practice Address - Street 1:320-3 MERRICK RD
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701
Practice Address - Country:US
Practice Address - Phone:631-691-0200
Practice Address - Fax:631-691-0202
Is Sole Proprietor?:No
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist