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General NPI Number Information
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NPI Number | 1902646201
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Entity Type | Individual
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Provider Name | MELVIN CASEY
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Gender | Male
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Dates
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Enumeration Date | 05/27/2024
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Last Update Date | 05/27/2024
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Provider Practice Location Address
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Address Line | 473 RIVER RD STE 139
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City | EDGEWATER
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State | NJ
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Zip | 07020-1145
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Country | US
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Telephone | 201-668-8088
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Fax |
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Provider Business Mailing Address
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Address Line | 4536 HUDSON AVE
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City | UNION CITY
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State | NJ
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Zip | 07087-7160
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Country | US
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Telephone | 201-668-8088
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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 | 18KT00108800
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License Number State | NJ
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