Individual
BIANCA BLAZE LUPARELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
73 CARLTON AVE APT C39, PORT WASHINGTON, NY 11050-3548
(516) 491-4117
Mailing address
73 CARLTON AVE APT C39, PORT WASHINGTON, NY 11050-3548
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
NY
Other
Enumeration date
10/29/2019
Last updated
10/29/2019
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