Individual
SOMLAK SANDAENG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1214 ROUTE 37 E, TOMS RIVER, NJ 08753-5752
(732) 270-8424
Mailing address
1214 ROUTE 37 E, TOMS RIVER, NJ 08753-5752
(732) 270-8424
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
18KT0122340
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
81-4580365
OPTOM
NJ
Enumeration date
09/20/2019
Last updated
09/20/2019
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