Individual
ALEKSANDR DEGTYAREV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
318 WYNN LN, PORT JEFFERSON, NY 11777-1670
(917) 224-0464
Mailing address
81 WESTCHESTER DR, ROCKY POINT, NY 11778-8875
(917) 224-0464
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
032816
NY
Other
Enumeration date
06/13/2023
Last updated
06/13/2023
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