Provider Demographics
NPI:1487106357
Name:DURAN, JOANNE (LAC,LMT,LPN)
Entity type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:
Last Name:DURAN
Suffix:
Gender:F
Credentials:LAC,LMT,LPN
Other - Prefix:MS
Other - First Name:JOANN
Other - Middle Name:C
Other - Last Name:DURAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:320 DECATUR AVE
Mailing Address - Street 2:
Mailing Address - City:EAST YAPHANK
Mailing Address - State:NY
Mailing Address - Zip Code:11967-1615
Mailing Address - Country:US
Mailing Address - Phone:631-295-7993
Mailing Address - Fax:
Practice Address - Street 1:320 DECATUR AVENUE
Practice Address - Street 2:
Practice Address - City:EAST YAPHANK
Practice Address - State:NY
Practice Address - Zip Code:11967
Practice Address - Country:US
Practice Address - Phone:631-433-6826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-26
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY263687-1164W00000X
NY023381-1172M00000X
NY006635-01171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No172M00000XOther Service ProvidersMechanotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0521Medicaid