Individual
MR. MAXWELL ENNIST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
210 BEDFORD PARK BLVD, BRONX, NY 10467
(914) 315-9088
Mailing address
3504 ROCHAMBEAU AVE APT 1J, BRONX, NY 10467-1376
(914) 315-9088
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
0308231
NY
Other
Enumeration date
10/09/2020
Last updated
10/09/2020
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