Healthcare Provider Details

I. General information

NPI: 1538018197
Provider Name (Legal Business Name): AMB LMT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2026
Last Update Date: 01/27/2026
Certification Date: 01/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 TIDE MILL RD
SAINT JAMES NY
11780-9626
US

IV. Provider business mailing address

6 TIDE MILL RD
SAINT JAMES NY
11780-9626
US

V. Phone/Fax

Practice location:
  • Phone: 631-759-0072
  • Fax:
Mailing address:
  • Phone: 631-759-0072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANDREA BOLTWOOD
Title or Position: PRESIDENT
Credential:
Phone: 631-759-0072