Provider Demographics
NPI:1881937324
Name:COLETTI, JUSTIN K (LAC, LMT)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:K
Last Name:COLETTI
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 1:20 CLARKSON AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-1991
Mailing Address - Country:US
Mailing Address - Phone:917-652-9956
Mailing Address - Fax:
Practice Address - Street 1:20 CLARKSON AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-1991
Practice Address - Country:US
Practice Address - Phone:917-652-9956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4892171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist