Individual
MR. JASON CHARLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT, LMBT
Contact information
Practice address
1324 FOREST AVE, STE 125, STATEN ISLAND, NY 10302-2044
(646) 838-1729
Mailing address
1324 FOREST AVE, STE 125, STATEN ISLAND, NY 10302-2044
(646) 838-1729
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
030754
NY
225700000X
Massage Therapist
18KT00810300
NJ
Other
Enumeration date
05/10/2016
Last updated
10/21/2017
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