Provider Demographics
NPI:1730621517
Name:REMIEN, JAMES (LMT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:REMIEN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 LAKE AVE SOUTH, SUITE C
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767
Mailing Address - Country:US
Mailing Address - Phone:631-584-8783
Mailing Address - Fax:631-584-8784
Practice Address - Street 1:62 LAKE AVE SOUTH, SUITE C
Practice Address - Street 2:
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767
Practice Address - Country:US
Practice Address - Phone:631-584-8783
Practice Address - Fax:631-584-8784
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-10
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024423225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist