Healthcare Provider Details

I. General information

NPI: 1942713003
Provider Name (Legal Business Name): JOAN WITTIG BC-DMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2017
Last Update Date: 11/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 W 26TH ST RM 309
NEW YORK NY
10001-5518
US

IV. Provider business mailing address

414 ALBEMARLE RD APT 1G
BROOKLYN NY
11218-2338
US

V. Phone/Fax

Practice location:
  • Phone: 212-252-2465
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225600000X
TaxonomyDance Therapist
License Number000032
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: