Provider Demographics
NPI:1073919536
Name:HOLISTIC WELLBEING
Entity Type:Organization
Organization Name:HOLISTIC WELLBEING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SUYOSA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-687-2474
Mailing Address - Street 1:115 W 30TH ST
Mailing Address - Street 2:SUITE 500 B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-4010
Mailing Address - Country:US
Mailing Address - Phone:212-764-3924
Mailing Address - Fax:
Practice Address - Street 1:9050 PARSONS BLVD
Practice Address - Street 2:SUITE 410
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-6012
Practice Address - Country:US
Practice Address - Phone:718-687-2474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-11
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036209225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty