Provider Demographics
NPI:1629700877
Name:ALICEA, JOSHUA (LMT)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:ALICEA
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 ELEANOR AVE
Mailing Address - Street 2:
Mailing Address - City:MASTIC
Mailing Address - State:NY
Mailing Address - Zip Code:11950-5212
Mailing Address - Country:US
Mailing Address - Phone:631-336-4500
Mailing Address - Fax:
Practice Address - Street 1:193 N WELLWOOD AVE
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-4005
Practice Address - Country:US
Practice Address - Phone:631-842-2424
Practice Address - Fax:631-842-2082
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029213225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty