Individual
NICOLE IRENE BRODERICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
99 E MAIN ST STE 1, EAST ISLIP, NY 11730-2538
(631) 647-8324
(631) 352-0051
Mailing address
99 E MAIN ST STE 1, EAST ISLIP, NY 11730-2538
(631) 647-8324
(631) 352-0051
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
016018-1
NY
Other
Enumeration date
01/23/2020
Last updated
01/23/2020
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