Healthcare Provider Details

I. General information

NPI: 1316165228
Provider Name (Legal Business Name): DANILO JEREMY CUELLAR L. AC., LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 EXECUTIVE BLVD STE 205
SUFFERN NY
10901-4157
US

IV. Provider business mailing address

1 EXECUTIVE BLVD STE 205
SUFFERN NY
10901-4157
US

V. Phone/Fax

Practice location:
  • Phone: 845-623-5000
  • Fax:
Mailing address:
  • Phone: 845-623-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number015491
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number003122
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: