MEDICARE: GREEN AURA MASSAGE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1063108074
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREEN AURA MASSAGE LLC

Provider Business Mailing Address
First Line	:	3409 STEINWAY ST
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-1319
Country	:	US
Telephone Number	:	929-624-2688
Fax Number	:

Provider Business Practice Location Address
First Line	:	3409 STEINWAY ST
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-1319
Country	:	US
Telephone Number	:	929-624-2688
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MAURA CHOI
Credential	:	LMT
Telephone Number	:	929-624-2688

Provider Enumeration Date	:	04/13/2023
Last Update Date	:	04/13/2023

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