Individual
ILIA GERASSIMOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
14 CENTER ST, LITTLE FERRY, NJ 07643-1803
(718) 506-4515
Mailing address
14 CENTER ST, LITTLE FERRY, NJ 07643-1803
(718) 506-4515
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
024648
NY
Other
Enumeration date
03/27/2021
Last updated
03/27/2021
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