Healthcare Provider Details

I. General information

NPI: 1619274537
Provider Name (Legal Business Name): JODIE TASSELLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2011
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 S GREENBUSH RD
ORANGEBURG NY
10962-1322
US

IV. Provider business mailing address

103 S GREENBUSH RD
ORANGEBURG NY
10962-1322
US

V. Phone/Fax

Practice location:
  • Phone: 914-261-1495
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number004419
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: