Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 18KT01251600 | NJ |
NPI | 1013522515 |
---|---|
Provider Name | Elsie Patricia Contreras |
First Address | West New York, NJ 07093-1628 |
Second Address | West New York, NJ 07093-1628 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2020 |
Last Update Date | 10/09/2020 |