Provider Demographics
NPI:1508357591
Name:JEAN LOUIS, MIRLANDE (LMT)
Entity Type:Individual
Prefix:
First Name:MIRLANDE
Middle Name:
Last Name:JEAN LOUIS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 W 62ND ST APT 6D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7308
Mailing Address - Country:US
Mailing Address - Phone:917-817-7212
Mailing Address - Fax:
Practice Address - Street 1:124 E 40TH ST RM 1001
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1765
Practice Address - Country:US
Practice Address - Phone:917-817-7212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY27-024922225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist