Individual
JONATHAN MICHAEL WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1386 ROUTE 25A, EAST SETAUKET, NY 11733-2842
(631) 751-2375
Mailing address
1386 ROUTE 25A, EAST SETAUKET, NY 11733-2842
(631) 751-2374
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
027140-1
NY
Other
Enumeration date
09/21/2020
Last updated
09/21/2020
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