MEDICARE: MR. RONALD JAMES CASELNOVA I MASSAGE THERAPIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	004282	NY

General Provider Information

NPI Number	:	1003152851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RONALD JAMES CASELNOVA I MASSAGE THERAPIST

Provider Business Mailing Address
First Line	:	7725 5TH AVE
Second Line	:	NONE
City	:	BROOKLYN
State	:	NY
Zip	:	11209-3311
Country	:	US
Telephone Number	:	718-921-2680
Fax Number	:	718-921-8768

Provider Business Practice Location Address
First Line	:	7725 5TH AVE
Second Line	:	NONE
City	:	BROOKLYN
State	:	NY
Zip	:	11209-3311
Country	:	US
Telephone Number	:	718-921-2680
Fax Number	:	718-921-8768

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/26/2012
Last Update Date	:	12/26/2012

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