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General NPI Number Information
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NPI Number | 1942082763
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Entity Type | Organization
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Legal Business Name | LONG ISLAND MASSAGE, PLLC
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Dates
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Enumeration Date | 10/17/2023
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Last Update Date | 12/17/2023
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Provider Practice Location Address
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Address Line | 32845 MAIN RD
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City | CUTCHOGUE
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State | NY
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Zip | 11935-1691
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Country | US
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Telephone | 631-464-3882
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Fax |
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Provider Business Mailing Address
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Address Line | 32845 MAIN RD
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City | CUTCHOGUE
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State | NY
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Zip | 11935-1691
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | N N
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Credential |
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Telephone | 631-464-3882
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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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