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General NPI Number Information
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NPI Number | 1548572159
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Entity Type | Organization
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Legal Business Name | JP VERDISCO EXERCISE HEALTH AND FITNESS INC.
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Dates
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Enumeration Date | 07/12/2010
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Last Update Date | 07/12/2010
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Provider Practice Location Address
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Address Line | 1305 MIDDLE COUNTRY RD
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City | SELDEN
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State | NY
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Zip | 11784-2554
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Country | US
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Telephone | 631-880-3810
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Fax |
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Provider Business Mailing Address
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Address Line | 1305 MIDDLE COUNTRY RD
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City | SELDEN
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State | NY
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Zip | 11784-2554
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Country | US
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Telephone | 631-880-3810
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Fax |
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Authorized Official
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Title or Position | CLINICAL EXERCISE PHYSIOLOGIST
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Name | JAMES PAUL VERDISCO
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Credential | BA/MA
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Telephone | 631-880-3810
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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 | 0147861
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License Number State | NY
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