Provider Demographics
NPI:1063780898
Name:VENA, ROBERT A (LAC, MSTOM)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:A
Last Name:VENA
Suffix:
Gender:M
Credentials:LAC, MSTOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 BROADWAY
Mailing Address - Street 2:SUITE 1119
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-7903
Mailing Address - Country:US
Mailing Address - Phone:201-655-2119
Mailing Address - Fax:
Practice Address - Street 1:208 ANDERSON ST
Practice Address - Street 2:SOUTH-7C
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-3517
Practice Address - Country:US
Practice Address - Phone:201-655-2119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004672-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist