Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 029362 | NY |
NPI | 1003420704 |
---|---|
Provider Name | Amanda Joy Berman |
First Address | New York, NY 10075-1404 |
Second Address | New York, NY 10075-1404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2020 |
Last Update Date | 01/09/2020 |