Provider Demographics
NPI:1619603552
Name:SAVOCA, JOHN JOSEPH (MTH)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:JOSEPH
Last Name:SAVOCA
Suffix:
Gender:M
Credentials:MTH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 GANNET DR
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-4919
Mailing Address - Country:US
Mailing Address - Phone:602-321-6140
Mailing Address - Fax:
Practice Address - Street 1:57 GANNET DR
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-4919
Practice Address - Country:US
Practice Address - Phone:602-321-6140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003117225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist