Healthcare Provider Details

I. General information

NPI: 1689304891
Provider Name (Legal Business Name): JESSICA MEJIAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 06/13/2022
Certification Date: 06/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 W 34TH ST RM 204
NEW YORK NY
10001-3011
US

IV. Provider business mailing address

2058 E 57TH ST
BROOKLYN NY
11234-4702
US

V. Phone/Fax

Practice location:
  • Phone: 212-600-4808
  • Fax:
Mailing address:
  • Phone: 347-444-1348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number032970-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: