Provider Demographics
NPI:1902626559
Name:MAINENTI, DAVID C (L AC, DIPL OM)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:C
Last Name:MAINENTI
Suffix:
Gender:M
Credentials:L AC, DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 BALDWIN AVE
Mailing Address - Street 2:
Mailing Address - City:LOCUST VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11560-1904
Mailing Address - Country:US
Mailing Address - Phone:516-801-4837
Mailing Address - Fax:
Practice Address - Street 1:192 GLEN ST
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2710
Practice Address - Country:US
Practice Address - Phone:516-548-7168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007560171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist