Healthcare Provider Details

I. General information

NPI: 1629660220
Provider Name (Legal Business Name): RICHARD GASCON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2021
Last Update Date: 02/05/2021
Certification Date: 02/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 HEMPSTEAD TPKE
FARMINGDALE NY
11735-2034
US

IV. Provider business mailing address

83 GELSTON AVE
BROOKLYN NY
11209-6007
US

V. Phone/Fax

Practice location:
  • Phone: 516-755-5855
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number005632-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: