Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 030108 | NY |
NPI | 1013425891 |
---|---|
Provider Name | Joseph Miguel Baquet |
First Address | Levittown, NY 11756-2125 |
Second Address | Lindenhurst, NY 11757-1677 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2018 |
Last Update Date | 16/01/2018 |