Provider Demographics
NPI:1265830715
Name:JADELEAF MASSAGE THERAPY P.C.
Entity Type:Organization
Organization Name:JADELEAF MASSAGE THERAPY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ALISA
Authorized Official - Middle Name:
Authorized Official - Last Name:EVELYN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-484-3496
Mailing Address - Street 1:280 MADISON AVE
Mailing Address - Street 2:STE. 807
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-0801
Mailing Address - Country:US
Mailing Address - Phone:917-484-3486
Mailing Address - Fax:
Practice Address - Street 1:280 MADISON AVE
Practice Address - Street 2:STE. 807
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0801
Practice Address - Country:US
Practice Address - Phone:917-484-3486
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY27027213225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty