Healthcare Provider Details

I. General information

NPI: 1982578563
Provider Name (Legal Business Name): PEGGY MCLOUGHLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 10/06/2025
Certification Date: 10/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6144 ROUTE 25A STE 9
WADING RIVER NY
11792-2015
US

IV. Provider business mailing address

45 HIDDEN ACRES PATH
WADING RIVER NY
11792-2208
US

V. Phone/Fax

Practice location:
  • Phone: 631-375-3997
  • Fax:
Mailing address:
  • Phone: 631-375-3997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number027666
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: