Provider Demographics
NPI:1851171763
Name:GREEN SPA NEW YORK, INC.
Entity Type:Organization
Organization Name:GREEN SPA NEW YORK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO FOUNDER LMT
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRODY
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:718-921-6100
Mailing Address - Street 1:8804 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-5664
Mailing Address - Country:US
Mailing Address - Phone:718-921-6100
Mailing Address - Fax:
Practice Address - Street 1:8804 3RD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-5664
Practice Address - Country:US
Practice Address - Phone:718-921-6100
Practice Address - Fax:718-921-4564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty