Provider Demographics
NPI:1700039856
Name:MIDDAY MASSAGE
Entity Type:Organization
Organization Name:MIDDAY MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERRE
Authorized Official - Suffix:
Authorized Official - Credentials:MASSAGE THERAPY
Authorized Official - Phone:631-940-6095
Mailing Address - Street 1:119 CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-1326
Mailing Address - Country:US
Mailing Address - Phone:631-940-6095
Mailing Address - Fax:
Practice Address - Street 1:1739 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-5206
Practice Address - Country:US
Practice Address - Phone:631-940-6095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-01
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021951173C00000X
225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No173C00000XOther Service ProvidersReflexologistGroup - Multi-Specialty