Provider Demographics
NPI:1003421074
Name:MASSAGEBYWEN PLLC
Entity Type:Organization
Organization Name:MASSAGEBYWEN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WENDELL
Authorized Official - Middle Name:OLIVER
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-463-1236
Mailing Address - Street 1:24028 MEMPHIS AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-2017
Mailing Address - Country:US
Mailing Address - Phone:347-463-1236
Mailing Address - Fax:
Practice Address - Street 1:24028 MEMPHIS AVE
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-2017
Practice Address - Country:US
Practice Address - Phone:347-463-1236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health