MEDICARE: MR. CHRISTOPHER JAMES KWOZKO LMY

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	032139-01	NY

General Provider Information

NPI Number	:	1659946622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRISTOPHER JAMES KWOZKO LMY

Provider Business Mailing Address
First Line	:	64 E HUDSON ST
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-2107
Country	:	US
Telephone Number	:	631-219-1923
Fax Number	:

Provider Business Practice Location Address
First Line	:	1487 BLUE SPRUCE LN
Second Line	:
City	:	WANTAGH
State	:	NY
Zip	:	11793-2528
Country	:	US
Telephone Number	:	516-368-4050
Fax Number	:

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

Provider Enumeration Date	:	05/23/2021
Last Update Date	:	05/23/2021

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