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General NPI Number Information
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NPI Number | 1265830715
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Entity Type | Organization
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Legal Business Name | JADELEAF MASSAGE THERAPY P.C.
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Dates
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Enumeration Date | 12/16/2014
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Last Update Date | 12/16/2014
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Provider Practice Location Address
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Address Line | 280 MADISON AVE STE. 807
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City | NEW YORK
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State | NY
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Zip | 10016-0801
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Country | US
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Telephone | 917-484-3486
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Fax |
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Provider Business Mailing Address
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Address Line | 280 MADISON AVE STE. 807
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City | NEW YORK
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State | NY
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Zip | 10016-0801
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Country | US
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Telephone | 917-484-3486
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Fax |
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Authorized Official
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Title or Position | MASSAGE THERAPIST
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Name | MS. ALISA EVELYN
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Credential |
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Telephone | 917-484-3496
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 27027213
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License Number State | NY
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