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General NPI Number Information
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NPI Number | 1639559701
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Entity Type | Individual
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Provider Name | NORA DIFABIO
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Gender | Female
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Dates
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Enumeration Date | 06/04/2015
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Last Update Date | 09/24/2021
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Provider Practice Location Address
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Address Line | 1050 HALLOCK AVE STE 3
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-1214
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Country | US
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Telephone | 516-736-4691
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Fax |
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Provider Business Mailing Address
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Address Line | 18 DEER AVE
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City | MIDDLE ISLAND
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State | NY
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Zip | 11953-1509
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Country | US
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Telephone | 516-314-1352
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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 | 016237-1
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License Number State | NY
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