Provider Demographics
NPI:1467673855
Name:MASANGKAY, MICHELLE (LAC)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:MASANGKAY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE FERRY
Mailing Address - State:NJ
Mailing Address - Zip Code:07643-1858
Mailing Address - Country:US
Mailing Address - Phone:201-388-7339
Mailing Address - Fax:
Practice Address - Street 1:159 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:LITTLE FERRY
Practice Address - State:NJ
Practice Address - Zip Code:07643-1858
Practice Address - Country:US
Practice Address - Phone:201-388-7339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00145200171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist