Individual
MR. MICHAEL DOMENICK TENERELLI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
10 CORTEZ LN, KINGS PARK, NY 11754-4518
(631) 379-3159
Mailing address
10 CORTEZ LN, KINGS PARK, NY 11754-4518
(631) 379-3159
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
032715-01
NY
Other
Enumeration date
12/26/2021
Last updated
12/26/2021
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