Individual
VINCENT P PAGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
271 LAKE AVE S, NESCONSET, NY 11767-1853
(631) 291-5083
Mailing address
271 LAKE AVE S, NESCONSET, NY 11767-1853
(631) 291-5083
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
031792
NY
Other
Enumeration date
07/22/2020
Last updated
07/22/2020
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