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General NPI Number Information
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NPI Number | 1225736465
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Entity Type | Individual
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Provider Name | JAJA BOLDEN
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Gender | Male
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Dates
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Enumeration Date | 02/17/2023
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Last Update Date | 02/17/2023
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Provider Practice Location Address
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Address Line | 232 VARET ST
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City | BROOKLYN
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State | NY
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Zip | 11206-3862
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Country | US
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Telephone | 347-670-4913
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Fax |
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Provider Business Mailing Address
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Address Line | 512 W 156TH ST APT 31
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City | NEW YORK
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State | NY
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Zip | 10032-7837
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Country | US
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Telephone | 347-670-4913
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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 | 028349
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License Number State | NY
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