Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 013075 | NY |
NPI | 1003479650 |
---|---|
Provider Name | Ms. Maureen Ann Magner |
First Address | Baldwin, NY 11510-0110 |
Second Address | North Baldwin, NY 11510-1617 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2019 |
Last Update Date | 18/04/2019 |