Provider Demographics
NPI:1831652981
Name:MACIAS, LUIS ANGEL (LMT)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:ANGEL
Last Name:MACIAS
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 1:153 W 27TH ST STE 404
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6258
Mailing Address - Country:US
Mailing Address - Phone:917-562-2285
Mailing Address - Fax:
Practice Address - Street 1:153 W 27TH ST STE 404
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6258
Practice Address - Country:US
Practice Address - Phone:917-562-2285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-06
Last Update Date:2019-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028334225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty