Basic Information
| Provider Information | |||||||||
| NPI: | 1003152851 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASELNOVA | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | I | ||||||||
| Credential: | MASSAGE THERAPIST | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CASELNOVA | ||||||||
| OtherFirstName: | RONALD | ||||||||
| OtherMiddleName: | JAMES | ||||||||
| OtherNamePrefix: | MR. | ||||||||
| OtherNameSuffix: | I | ||||||||
| OtherCredential: | MASSAGE THERAPIST | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7725 5TH AVE | ||||||||
| Address2: | NONE | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112093311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189212680 | ||||||||
| FaxNumber: | 7189218768 | ||||||||
| Practice Location | |||||||||
| Address1: | 7725 5TH AVE | ||||||||
| Address2: | NONE | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112093311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189212680 | ||||||||
| FaxNumber: | 7189218768 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/26/2012 | ||||||||
| LastUpdateDate: | 12/26/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | 004282 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.