Individual
BONNIE TAUB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
640 BELLE TERRE RD STE J2, PORT JEFFERSON, NY 11777-1936
(631) 476-3903
Mailing address
16 RADFORD RD, LAKE GROVE, NY 11755-2610
(631) 585-1092
(631) 738-7825
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
010745
NY
Other
Enumeration date
10/14/2006
Last updated
07/08/2007
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