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General NPI Number Information
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NPI Number | 1023605466
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Entity Type | Organization
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Legal Business Name | THE JUNIPER HOUSE, INCORPORATED
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Dates
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Enumeration Date | 12/30/2020
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Last Update Date | 12/30/2020
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Provider Practice Location Address
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Address Line | 34 OCEAN AVE
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City | ISLIP
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State | NY
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Zip | 11751-3804
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Country | US
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Telephone | 631-871-7938
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Fax |
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Provider Business Mailing Address
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Address Line | 34 OCEAN AVE
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City | ISLIP
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State | NY
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Zip | 11751-3804
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Country | US
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Telephone | 631-871-7938
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALISSA DANDRILLI LATERZA
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Credential |
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Telephone | 631-871-7938
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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