Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 023173 | NY |
NPI | 1003464587 |
---|---|
Provider Name | Victor Brian Misyuk |
First Address | Brooklyn, NY 11237-6427 |
Second Address | Brooklyn, NY 11237-6427 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2019 |
Last Update Date | 28/08/2019 |