Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 004282 | NY |
NPI | 1003152851 |
---|---|
Provider Name | Mr. Ronald James Caselnova I |
First Address | Brooklyn, NY 11209-3311 |
Second Address | Brooklyn, NY 11209-3311 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2012 |
Last Update Date | 26/12/2012 |