Healthcare Provider Details

I. General information

NPI: 1366387516
Provider Name (Legal Business Name): DIAMARIS LAUREANO MSG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2562 FISH AVE
BRONX NY
10469-5613
US

IV. Provider business mailing address

2562 FISH AVE
BRONX NY
10469-5613
US

V. Phone/Fax

Practice location:
  • Phone: 917-557-1717
  • Fax:
Mailing address:
  • Phone: 917-557-1717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number032837-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: