Provider Demographics
NPI:1184877060
Name:FAMA, DENNIS (LAC)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:
Last Name:FAMA
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 1:23 RODSFIELD CT
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-5911
Mailing Address - Country:US
Mailing Address - Phone:631-525-3090
Mailing Address - Fax:
Practice Address - Street 1:23 RODSFIELD CT
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-5911
Practice Address - Country:US
Practice Address - Phone:631-525-3090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003947171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist