1700398500 NPI number — NEW YORK MASSAGE COMPANY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700398500 NPI number — NEW YORK MASSAGE COMPANY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW YORK MASSAGE COMPANY
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:
6
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:
1700398500
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1534
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIGHLAND
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48357
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-310-7262
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1181 NORTH MILFORD RD.
Provider Second Line Business Practice Location Address:
3 205
Provider Business Practice Location Address City Name:
MILFORD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48381
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-310-7262
Provider Business Practice Location Address Fax Number:
248-295-3787
Provider Enumeration Date:
11/02/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BARSOUM
Authorized Official First Name:
MAHER
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
248-310-7262

Provider Taxonomy Codes

  • Taxonomy code: 171100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225700000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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