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General NPI Number Information
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NPI Number | 1124493630
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Entity Type | Organization
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Legal Business Name | WEST NEW YORK HEALTH CENTER
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Dates
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Enumeration Date | 12/09/2015
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Last Update Date | 12/09/2015
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Provider Practice Location Address
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Address Line | 5300 BERGENLINE AVE STE 1
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City | WEST NEW YORK
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State | NJ
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Zip | 07093-5595
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Country | US
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Telephone | 201-855-1635
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Fax |
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Provider Business Mailing Address
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Address Line | 5300 BERGENLINE AVE STE 1
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City | WEST NEW YORK
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State | NJ
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Zip | 07093-5595
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Country | US
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Telephone | 201-855-1635
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. DANTE JOA
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Credential | LMT
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Telephone | 201-855-1635
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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 | 18KT00182200
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License Number State | NJ
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