Individual
JACKIE WEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
67 MANHATTAN AVE APT 14H, BROOKLYN, NY 11206-3113
(347) 922-5141
Mailing address
67 MANHATTAN AVE APT 14H, BROOKLYN, NY 11206-3113
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
033129
NY
Other
Enumeration date
02/28/2023
Last updated
02/28/2023
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