Healthcare Provider Details

I. General information

NPI: 1003747569
Provider Name (Legal Business Name): LIBIO CARCASSES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 E 20TH ST APT 4C
NEW YORK NY
10009-1323
US

IV. Provider business mailing address

530 E 20TH ST APT 4C
NEW YORK NY
10009-1323
US

V. Phone/Fax

Practice location:
  • Phone: 347-237-1379
  • Fax:
Mailing address:
  • Phone: 347-237-1379
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number033034-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: