Individual
TIA TRIVISONNO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.AC
Contact information
Practice address
997 GLEN COVE AVE, GLEN HEAD, NY 11545-1593
(516) 801-1405
(516) 759-5946
Mailing address
997 GLEN COVE AVE, GLEN HEAD, NY 11545-1593
(516) 801-1405
(516) 759-5946
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
004667
NY
Other
Enumeration date
09/20/2011
Last updated
09/20/2011
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