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General NPI Number Information
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NPI Number | 1235829615
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Entity Type | Individual
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Provider Name | NATHANIA BERNADIN LMT
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Gender | Female
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Dates
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Enumeration Date | 05/10/2023
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Last Update Date | 05/10/2023
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Provider Practice Location Address
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Address Line | 900 LAKE ST SUITE 900 C-10
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City | RAMSEY
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State | NJ
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Zip | 07446
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Country | US
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Telephone | 845-269-0006
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 75
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City | PARK RIDGE
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State | NJ
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Zip | 07656-0075
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Country | US
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Telephone | 845-269-0006
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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 | 18KT00512800
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License Number State | NJ
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