Healthcare Provider Details

I. General information

NPI: 1063182129
Provider Name (Legal Business Name): SYLWIA DOROTA DJOKIC LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2021
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 24TH ST
COPIAGUE NY
11726-2902
US

IV. Provider business mailing address

78 24TH ST
COPIAGUE NY
11726-2902
US

V. Phone/Fax

Practice location:
  • Phone: 631-708-4248
  • Fax:
Mailing address:
  • Phone: 631-708-4248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number031913-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: