Provider Demographics
NPI:1932338456
Name:VENEZIANO, PHIL (MS LAC)
Entity Type:Individual
Prefix:MR
First Name:PHIL
Middle Name:
Last Name:VENEZIANO
Suffix:
Gender:M
Credentials:MS LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 PRINCE STREET
Mailing Address - Street 2:#501-A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012
Mailing Address - Country:US
Mailing Address - Phone:917-210-1068
Mailing Address - Fax:
Practice Address - Street 1:177 PRINCE STREET
Practice Address - Street 2:#501-A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012
Practice Address - Country:US
Practice Address - Phone:917-210-1068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3981171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist