Provider Demographics
NPI:1528750072
Name:HORMADALY, YONATHAN
Entity type:Individual
Prefix:
First Name:YONATHAN
Middle Name:
Last Name:HORMADALY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 DANBURY RD STE D1
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-4142
Mailing Address - Country:US
Mailing Address - Phone:203-550-6888
Mailing Address - Fax:
Practice Address - Street 1:109 DANBURY RD STE D1
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4142
Practice Address - Country:US
Practice Address - Phone:203-550-6888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003010225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist