Provider Demographics
NPI:1578177622
Name:SURYA WELLNESS MASSAGE THERAPY PLLC
Entity Type:Organization
Organization Name:SURYA WELLNESS MASSAGE THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WARRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-235-4943
Mailing Address - Street 1:125 W SHORE RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2042
Mailing Address - Country:US
Mailing Address - Phone:631-235-4943
Mailing Address - Fax:
Practice Address - Street 1:125 W SHORE RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2042
Practice Address - Country:US
Practice Address - Phone:631-235-4943
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-06
Last Update Date:2020-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty