Individual
MARK DOHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAC, LMT
Contact information
Practice address
623 BROADWAY, MASSAPEQUA, NY 11758-5027
(516) 781-1078
Mailing address
623 BROADWAY, MASSAPEQUA, NY 11758-5027
(516) 781-1078
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
007088
NY
225700000X
Massage Therapist
030560
NY
Other
Enumeration date
10/14/2019
Last updated
02/17/2022
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