Provider Demographics
NPI:1922331826
Name:RANCES, MARIVIE (LMT)
Entity Type:Individual
Prefix:
First Name:MARIVIE
Middle Name:
Last Name:RANCES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 LAKEVILLE RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1165
Mailing Address - Country:US
Mailing Address - Phone:516-504-4040
Mailing Address - Fax:516-482-1948
Practice Address - Street 1:444 LAKEVILLE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1165
Practice Address - Country:US
Practice Address - Phone:516-504-4040
Practice Address - Fax:516-482-1948
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012995-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY012995-1OtherNYS MASSAGE LICENSE NUMBER