Healthcare Provider Details

I. General information

NPI: 1043036908
Provider Name (Legal Business Name): NOEMIE DAZA LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NOEMIE LAMPRON

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 OLD SOUTH COUNTRY RD
BROOKHAVEN NY
11719-9526
US

IV. Provider business mailing address

41 OLD SOUTH COUNTRY RD
BROOKHAVEN NY
11719-9526
US

V. Phone/Fax

Practice location:
  • Phone: 516-888-6176
  • Fax:
Mailing address:
  • Phone: 516-888-6176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number033740-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: