Provider Demographics
NPI:1417319252
Name:EMERGE YOGA & WELLNESS
Entity Type:Organization
Organization Name:EMERGE YOGA & WELLNESS
Other - Org Name:EMERGE INTEGRATIVE WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, CFO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:C
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, LMT, RYT
Authorized Official - Phone:516-781-1078
Mailing Address - Street 1:623 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-5027
Mailing Address - Country:US
Mailing Address - Phone:516-781-1078
Mailing Address - Fax:
Practice Address - Street 1:623 BROADWAY
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5027
Practice Address - Country:US
Practice Address - Phone:516-781-1078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171100000X
NY021089225700000X
NY203931225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty