Healthcare Provider Details

I. General information

NPI: 1942547252
Provider Name (Legal Business Name): JENNY ALICIA LOPEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2013
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PHENIX SALON SUITES 2575 HEMPSTEAD TPKE #109
EAST MEADOW NY
11554-2156
US

IV. Provider business mailing address

2575 HEMPSTEAD TPKE # 109
EAST MEADOW NY
11554-2156
US

V. Phone/Fax

Practice location:
  • Phone: 347-320-9390
  • Fax:
Mailing address:
  • Phone: 347-320-9390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number024586
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: