Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 024603-01 | NY |
NPI | 1003420191 |
---|---|
Provider Name | Jeffrey Dreon |
First Address | Whitestone, NY 11357-2838 |
Second Address | Whitestone, NY 11357-2838 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2020 |
Last Update Date | 04/09/2020 |