Individual
MICHAEL JOSEPH FALLON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
292 BRETTONWOODS DR, CORAM, NY 11727-3686
(631) 255-9836
Mailing address
292 BRETTONWOODS DR, CORAM, NY 11727-3686
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
030786
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
030786
NEW YORK STATE
NY
Enumeration date
04/12/2020
Last updated
04/12/2020
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