MEDICARE: MASSAGE EVOLUTION P.C.

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	:	1750263802
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MASSAGE EVOLUTION P.C.

Provider Business Mailing Address
First Line	:	2000 W FORT LEE RD APT 2215
Second Line	:
City	:	BOGOTA
State	:	NJ
Zip	:	07603-1549
Country	:	US
Telephone Number	:	646-285-4952
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 W 57TH ST STE BC
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10019-1752
Country	:	US
Telephone Number	:	646-285-4952
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. HOWARD STEPHEN MERMELSTEIN
Credential	:	LMT
Telephone Number	:	646-285-4952

Provider Enumeration Date	:	07/21/2025
Last Update Date	:	07/21/2025

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Directions to “MASSAGE EVOLUTION P.C. ” Practice Location

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