Healthcare Provider Details

I. General information

NPI: 1093885865
Provider Name (Legal Business Name): VANESSA VARTOLO L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6931 3RD AVE FL 2
BROOKLYN NY
11209-1304
US

IV. Provider business mailing address

1032 84TH ST
BROOKLYN NY
11228-2926
US

V. Phone/Fax

Practice location:
  • Phone: 917-697-3536
  • Fax: 718-876-6143
Mailing address:
  • Phone: 917-697-3536
  • Fax: 718-876-6143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number002343-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: