Healthcare Provider Details

I. General information

NPI: 1609674852
Provider Name (Legal Business Name): FSL TRAINING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2025
Last Update Date: 03/04/2025
Certification Date: 03/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 W 19TH STREET COMPLETE BODY
NEW YORK NY
10011
US

IV. Provider business mailing address

814 ROOSEVELT ST
WEST HEMPSTEAD NY
11552-3823
US

V. Phone/Fax

Practice location:
  • Phone: 718-683-6944
  • Fax:
Mailing address:
  • Phone: 718-683-6944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: DEON WALCOTT
Title or Position: DIRECTOR
Credential:
Phone: 717-186-8369