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General NPI Number Information
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NPI Number | 1063889384
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Entity Type | Individual
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Provider Name | JEAN PATRICK ELIE MT
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Gender | Male
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Dates
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Enumeration Date | 08/24/2015
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Last Update Date | 08/24/2015
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Provider Practice Location Address
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Address Line | 672 WELLWOOD AVE UNIT 2
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City | LINDENHURST
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State | NY
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Zip | 11757-1677
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Country | US
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Telephone | 561-225-2623
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Fax |
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Provider Business Mailing Address
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Address Line | 25 ROCKWOOD AVE
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City | MASSAPEQUA
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State | NY
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Zip | 11758-4745
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Country | US
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Telephone | 516-587-3337
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 028512-1
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License Number State | NY
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