Healthcare Provider Details

I. General information

NPI: 1285567107
Provider Name (Legal Business Name): SHAW W ENG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4245 KISSENA BLVD APT 2L
FLUSHING NY
11355-3249
US

IV. Provider business mailing address

4245 KISSENA BLVD APT 2L
FLUSHING NY
11355-3249
US

V. Phone/Fax

Practice location:
  • Phone: 609-759-1178
  • Fax:
Mailing address:
  • Phone: 609-759-1178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number034238
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: