Individual
JAY SUHERWANTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
225 FISHER AVE, WHITE PLAINS, NY 10606-2701
(415) 728-8505
Mailing address
225 FISHER AVE, WHITE PLAINS, NY 10606-2701
(415) 728-8505
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
019432
NY
Other
Enumeration date
06/13/2025
Last updated
06/13/2025
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