Healthcare Provider Details

I. General information

NPI: 1346838976
Provider Name (Legal Business Name): ANNETTE CALIENDO LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2021
Last Update Date: 01/08/2021
Certification Date: 01/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

457 N ONTARIO AVE
LINDENHURST NY
11757-3910
US

IV. Provider business mailing address

457 N ONTARIO AVE
LINDENHURST NY
11757-3910
US

V. Phone/Fax

Practice location:
  • Phone: 631-559-0069
  • Fax:
Mailing address:
  • Phone: 631-559-0069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number020815
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: