| Type | Legal entity | [sources] | |||
|---|---|---|---|---|---|
| Name | COLLYMORE STEFON | [sources] | |||
| Legal form | not available | [sources] | |||
| Country | United States | [sources] | |||
| ID Number | 00028483 | [sources] | |||
| NPI | 1114698651 | [sources] | |||
| Sector | Massage Therapist | [sources] | |||
| Status | not available | [sources] | |||
| Last change | Last processed | First seen | |||
Medical providers deemed ineligible to participate in New York State's Medicaid program.
United States · OMIG
us-medny-919dda69795e311cfbc42d75215931aed5768c9b · us-npi-1114698651For experts: raw data explorer
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