Individual
MARK STEPHEN BANASZAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
6321 BALSAM FIR CT, CLARENCE CENTER, NY 14032-9150
(716) 864-9079
Mailing address
6321 BALSAM FIR CT, CLARENCE CENTER, NY 14032-9150
(716) 864-9079
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
019871
NY
Other
Enumeration date
03/07/2008
Last updated
03/07/2008
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