Provider Demographics
NPI:1669723458
Name:BIANCULLI, JOSEPH (LAC)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:BIANCULLI
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 50TH AVE APT 4H
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-4512
Mailing Address - Country:US
Mailing Address - Phone:631-831-0307
Mailing Address - Fax:
Practice Address - Street 1:226 50TH AVE APT 4H
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-4512
Practice Address - Country:US
Practice Address - Phone:631-831-0307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004912-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist