Healthcare Provider Details

I. General information

NPI: 1902512676
Provider Name (Legal Business Name): ENINNAJ SKIN & BODY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2023
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5254 MERRICK RD STE 18
MASSAPEQUA NY
11758-6206
US

IV. Provider business mailing address

5254 MERRICK RD STE 18
MASSAPEQUA NY
11758-6206
US

V. Phone/Fax

Practice location:
  • Phone: 754-444-2136
  • Fax:
Mailing address:
  • Phone: 754-444-2136
  • 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: JANNINE WAIGHT
Title or Position: MASSAGE THERAPIST
Credential: LMT
Phone: 754-444-2136