MEDICARE: THE SELF-CARE SUITE 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	:	1578266672
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE SELF-CARE SUITE LLC

Provider Business Mailing Address
First Line	:	208 AIRPORT PLAZA BLVD STE 27
Second Line	:
City	:	FARMINGDALE
State	:	NY
Zip	:	11735-3946
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	208 AIRPORT PLAZA BLVD STE 27
Second Line	:
City	:	FARMINGDALE
State	:	NY
Zip	:	11735-3946
Country	:	US
Telephone Number	:	516-206-0864
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER
Name	:	CYNTHIA FARINA
Credential	:	LMT
Telephone Number	:	516-206-0864

Provider Enumeration Date	:	03/27/2023
Last Update Date	:	04/20/2023

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Directions to “THE SELF-CARE SUITE LLC ” Practice Location

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