Provider Demographics
NPI:1528443124
Name:TARANTINO, WILLIAM JOHN (LAC)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:JOHN
Last Name:TARANTINO
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 1:2015 CENTRAL DR S
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-5118
Mailing Address - Country:US
Mailing Address - Phone:631-478-7002
Mailing Address - Fax:
Practice Address - Street 1:2015 CENTRAL DR S
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-5118
Practice Address - Country:US
Practice Address - Phone:631-478-7002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005608-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist