Individual
MATTHEW MODERNO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
2789 MILBURN AVE, BALDWIN, NY 11510-4119
(516) 457-7371
Mailing address
PO BOX 22, MERRICK, NY 11566-0022
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
028230
NY
Other
Enumeration date
05/12/2022
Last updated
05/12/2022
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