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General NPI Number Information
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NPI Number | 1639090145
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Entity Type | Organization
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Legal Business Name | MASSAGE THERAPIST LONG ISLAND PC
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Dates
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Enumeration Date | 07/22/2026
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Last Update Date | 07/22/2026
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Provider Practice Location Address
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Address Line | 114 BROADWAY
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City | MALVERNE
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State | NY
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Zip | 11565-1635
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Country | US
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Telephone | 516-887-8900
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Fax | 516-200-0100
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Provider Business Mailing Address
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Address Line | 114 BROADWAY
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City | MALVERNE
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State | NY
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Zip | 11565-1635
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Country | US
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Telephone | 516-887-8900
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Fax | 516-200-0100
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Authorized Official
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Title or Position | MANAGER
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Name | KRISTINA MILTCHEVA
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Credential | LMT
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Telephone | 516-887-8900
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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 |
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License Number State |
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