Healthcare Provider Details

I. General information

NPI: 1518197987
Provider Name (Legal Business Name): ANTHONY THOMAS SIACOTOS L.M.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2009
Last Update Date: 07/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 N BROADWAY
WHITE PLAINS NY
10601-2214
US

IV. Provider business mailing address

15 N BROADWAY
WHITE PLAINS NY
10601-2214
US

V. Phone/Fax

Practice location:
  • Phone: 914-946-3334
  • Fax:
Mailing address:
  • Phone: 914-946-3334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number006755
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: