Provider Demographics
NPI:1649410531
Name:LOSCALZO, JEAN (LMT)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:LOSCALZO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8555 115TH ST
Mailing Address - Street 2:APT A2
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-1757
Mailing Address - Country:US
Mailing Address - Phone:718-847-1613
Mailing Address - Fax:
Practice Address - Street 1:150 E 56TH ST
Practice Address - Street 2:SUITE 1 E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-3631
Practice Address - Country:US
Practice Address - Phone:718-847-1613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003351225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist