Healthcare Provider Details

I. General information

NPI: 1104142850
Provider Name (Legal Business Name): JOYCE A AZUKAS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2010
Last Update Date: 01/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2199 STATEROUTE 9
LAKE GEORGE NY
12845-6924
US

IV. Provider business mailing address

81 SKARA BRAE RD
LAKE GEORGE NY
12845-6924
US

V. Phone/Fax

Practice location:
  • Phone: 516-662-0939
  • Fax:
Mailing address:
  • Phone: 516-662-0939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number318395
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number016273-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: