Individual
MR. EDWARD JOHNATHAN DIPASQUALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
920 LINCOLN AVE STE 11&9, HOLBROOK, NY 11741-2257
(631) 256-5184
Mailing address
2 GRAVIN ST, CORAM, NY 11727-1439
(631) 838-9036
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
031912-01
NY
Other
Enumeration date
11/25/2019
Last updated
11/25/2019
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