Healthcare Provider Details

I. General information

NPI: 1114628211
Provider Name (Legal Business Name): ARLENE BALEGAN PAYOEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 ASTORIA BLVD
ASTORIA NY
11102-4358
US

IV. Provider business mailing address

2710 ASTORIA BLVD
ASTORIA NY
11102-4358
US

V. Phone/Fax

Practice location:
  • Phone: 929-777-8048
  • Fax:
Mailing address:
  • Phone: 929-777-8048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number27028768
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: