Healthcare Provider Details

I. General information

NPI: 1386564482
Provider Name (Legal Business Name): RAMIRO RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2026
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 50TH AVE FL 1
LONG ISLAND CITY NY
11101-6297
US

IV. Provider business mailing address

2618 HOYT AVE S APT 2C
ASTORIA NY
11102-2816
US

V. Phone/Fax

Practice location:
  • Phone: 917-725-0207
  • Fax:
Mailing address:
  • Phone: 917-439-6908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number022986-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: