Healthcare Provider Details

I. General information

NPI: 1801471420
Provider Name (Legal Business Name): MICHAEL ANDRYSZEWSKI LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2021
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 ROUTE 23B APT 6
SOUTH CAIRO NY
12482-1254
US

IV. Provider business mailing address

2425 ROUTE 23B APT 6
SOUTH CAIRO NY
12482-1254
US

V. Phone/Fax

Practice location:
  • Phone: 518-572-8582
  • Fax:
Mailing address:
  • Phone: 518-572-8582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number032404
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: