Provider Demographics
NPI:1669952115
Name:SUBLIME THERAPY
Entity type:Organization
Organization Name:SUBLIME THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:SORIANO
Authorized Official - Suffix:
Authorized Official - Credentials:LMT,MLD, CMMP
Authorized Official - Phone:201-374-2532
Mailing Address - Street 1:80 N WASHINGTON AVE UNIT L4
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-1771
Mailing Address - Country:US
Mailing Address - Phone:201-374-2532
Mailing Address - Fax:201-603-6970
Practice Address - Street 1:80 N WASHINGTON AVE
Practice Address - Street 2:UNITE L4
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621
Practice Address - Country:US
Practice Address - Phone:201-374-2532
Practice Address - Fax:201-603-6970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-15
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty