1649091216 NPI number — ELEVATE MASSAGE & BODYWORKS CORP

Table of content: MICHELLE KRISTEN DRAINS ND (NPI 1104314772)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649091216 NPI number — ELEVATE MASSAGE & BODYWORKS CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELEVATE MASSAGE & BODYWORKS CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649091216
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
765 VAN BUREN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST ISLIP
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11795-1337
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-943-1243
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
527 TOWNLINE RD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAUPPAUGE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11788-2833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-943-1243
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/17/2024

Additional Information

Authorized Official

Authorized Official Last Name:
KOLANO
Authorized Official First Name:
PAULA
Authorized Official Middle Name:
Authorized Official Title or Position:
LICENSED MASSAGE THERAPIST
Authorized Official Telephone Number:
631-943-1243

Provider Taxonomy Codes

  • Taxonomy code: 225700000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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