Provider Demographics
NPI:1073884334
Name:BELJOUR MASSAGE LLC
Entity Type:Organization
Organization Name:BELJOUR MASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:SARAH
Authorized Official - Last Name:BELJOUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-871-7780
Mailing Address - Street 1:1013 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-2409
Mailing Address - Country:US
Mailing Address - Phone:347-871-7780
Mailing Address - Fax:
Practice Address - Street 1:1013 FULTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-2409
Practice Address - Country:US
Practice Address - Phone:347-871-7780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024166171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty