Healthcare Provider Details

I. General information

NPI: 1497675334
Provider Name (Legal Business Name): SUPREME MASSAGE NYC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2532 168TH ST STE 218
FLUSHING NY
11358-1154
US

IV. Provider business mailing address

3434 BELL BLVD FL 2
BAYSIDE NY
11361-2374
US

V. Phone/Fax

Practice location:
  • Phone: 718-775-2743
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: FRANCISCO DIAZ
Title or Position: OWNER
Credential:
Phone: 718-500-7810