Healthcare Provider Details

I. General information

NPI: 1619668803
Provider Name (Legal Business Name): JEAN JOHNNY CIME
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 LINCOLN ST APT 1
STOUGHTON MA
02072-2560
US

IV. Provider business mailing address

188 LINCOLN ST APT 1
STOUGHTON MA
02072-2560
US

V. Phone/Fax

Practice location:
  • Phone: 857-243-7372
  • Fax:
Mailing address:
  • Phone: 857-243-7372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number17568
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: