Provider Demographics
NPI:1033499355
Name:SAYVILLE THERAPEUTIC SPA INC
Entity Type:Organization
Organization Name:SAYVILLE THERAPEUTIC SPA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WIESLAWA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALISZEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, LMT
Authorized Official - Phone:631-563-8955
Mailing Address - Street 1:120 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-2504
Mailing Address - Country:US
Mailing Address - Phone:631-563-8955
Mailing Address - Fax:631-563-1824
Practice Address - Street 1:120 MAIN ST
Practice Address - Street 2:
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782-2504
Practice Address - Country:US
Practice Address - Phone:631-563-8955
Practice Address - Fax:631-563-1824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004279-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty