Healthcare Provider Details

I. General information

NPI: 1689171662
Provider Name (Legal Business Name): CHRISTINA MARIE BIANCANIELLO MS, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2018
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E MAIN ST STE 2
SMITHTOWN NY
11787-2900
US

IV. Provider business mailing address

91 LUCILLE AVE
ELMONT NY
11003-2721
US

V. Phone/Fax

Practice location:
  • Phone: 631-780-6128
  • Fax:
Mailing address:
  • Phone: 516-668-2722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number005665-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: