Healthcare Provider Details

I. General information

NPI: 1356981732
Provider Name (Legal Business Name): HAROLD URRUTIA LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2020
Last Update Date: 08/30/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2260 HEWLETT AVE
MERRICK NY
11566-3951
US

IV. Provider business mailing address

34 HEMPSTEAD TPKE
SOUTH FARMINGDALE NY
11735-2034
US

V. Phone/Fax

Practice location:
  • Phone: 786-695-9107
  • Fax: 347-727-0505
Mailing address:
  • Phone: 516-755-5855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number025606
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: