Healthcare Provider Details

I. General information

NPI: 1609752088
Provider Name (Legal Business Name): JILL R LEWIS CORTAZAR LICENSED MASSAGE THE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2025
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 ATLANTIC AVE
EAST ROCKAWAY NY
11518-1530
US

IV. Provider business mailing address

38 VINCENT PL
LYNBROOK NY
11563-3755
US

V. Phone/Fax

Practice location:
  • Phone: 516-593-8333
  • Fax:
Mailing address:
  • Phone: 917-566-9048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number011444
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: