Individual
MISS NICOLE S FADER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
202 W PARK AVE, SUITE 201, LONG BEACH, NY 11561-3212
(516) 606-5473
Mailing address
202 W PARK AVE, SUITE 201, LONG BEACH, NY 11561-3212
(516) 606-5473
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
015711-1
NY
Other
Enumeration date
08/07/2007
Last updated
08/07/2007
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