Provider Demographics
NPI:1528491149
Name:HACKETT, LONDA OTTI (LAC)
Entity type:Individual
Prefix:
First Name:LONDA
Middle Name:OTTI
Last Name:HACKETT
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 NORTHERN BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5338
Mailing Address - Country:US
Mailing Address - Phone:516-482-0270
Mailing Address - Fax:516-482-0117
Practice Address - Street 1:1000 NORTHERN BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5338
Practice Address - Country:US
Practice Address - Phone:516-482-0270
Practice Address - Fax:516-482-0117
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002023171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist