Healthcare Provider Details

I. General information

NPI: 1750263802
Provider Name (Legal Business Name): MASSAGE EVOLUTION P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 W 57TH ST STE BC
NEW YORK NY
10019-1752
US

IV. Provider business mailing address

2000 W FORT LEE RD APT 2215
BOGOTA NJ
07603-1549
US

V. Phone/Fax

Practice location:
  • Phone: 646-285-4952
  • Fax:
Mailing address:
  • Phone: 646-285-4952
  • 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: MR. HOWARD STEPHEN MERMELSTEIN
Title or Position: PRESIDENT
Credential: LMT
Phone: 646-285-4952