Provider Demographics
NPI:1568039824
Name:TSUJI, CHISATO (LMT)
Entity Type:Individual
Prefix:
First Name:CHISATO
Middle Name:
Last Name:TSUJI
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 1:501 WASHINGTON AVE APT SIDE
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-1806
Mailing Address - Country:US
Mailing Address - Phone:347-782-8058
Mailing Address - Fax:
Practice Address - Street 1:501 WASHINGTON AVE APT SIDE
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-1806
Practice Address - Country:US
Practice Address - Phone:347-782-8058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026048-01225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY026-48-01OtherLICENSED MASSAGE THERAPIST