Provider Demographics
NPI:1073255139
Name:RENELIEN, STEVE (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:
Last Name:RENELIEN
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 ROSEDALE AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3307
Mailing Address - Country:US
Mailing Address - Phone:862-202-0781
Mailing Address - Fax:
Practice Address - Street 1:9 ROSEDALE AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3307
Practice Address - Country:US
Practice Address - Phone:862-202-0781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-10
Last Update Date:2022-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT01364600225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist