Provider Demographics
NPI:1003152851
Name:CASELNOVA, RONALD JAMES I (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:JAMES
Last Name:CASELNOVA
Suffix:I
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:MR
Other - First Name:RONALD
Other - Middle Name:JAMES
Other - Last Name:CASELNOVA
Other - Suffix:I
Other - Last Name Type:Other Name
Other - Credentials:MASSAGE THERAPIST
Mailing Address - Street 1:7725 5TH AVE
Mailing Address - Street 2:NONE
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3311
Mailing Address - Country:US
Mailing Address - Phone:718-921-2680
Mailing Address - Fax:718-921-8768
Practice Address - Street 1:7725 5TH AVE
Practice Address - Street 2:NONE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3311
Practice Address - Country:US
Practice Address - Phone:718-921-2680
Practice Address - Fax:718-921-8768
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-26
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004282225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist