Individual
JITLADDA BANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
25 W OAK ST, FARMINGDALE, NY 11735-3121
(516) 376-1503
Mailing address
25 W OAK ST, FARMINGDALE, NY 11735-3121
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
033328
NY
Other
Enumeration date
12/05/2023
Last updated
12/05/2023
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