Provider Demographics
NPI:1508416751
Name:CORDARO, TIMOTHY DANIEL (LMT)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:DANIEL
Last Name:CORDARO
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 1:930 N BROADWAY STE 100
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-2394
Mailing Address - Country:US
Mailing Address - Phone:516-778-7228
Mailing Address - Fax:
Practice Address - Street 1:930 N BROADWAY STE 100
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-2394
Practice Address - Country:US
Practice Address - Phone:516-778-7228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021764-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist