Individual
MICHAEL EDWARD DONNELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
1343 WANTAGH AVE, WANTAGH, NY 11793-2213
(516) 679-8299
Mailing address
1992 BERGEN ST, BELLMORE, NY 11710-3204
(516) 734-1669
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
031200
NY
Other
Enumeration date
09/09/2021
Last updated
09/09/2021
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