Provider Demographics
NPI:1962086686
Name:LYKES, MASON (TATTOO ARTIST)
Entity type:Individual
Prefix:
First Name:MASON
Middle Name:
Last Name:LYKES
Suffix:
Gender:F
Credentials:TATTOO ARTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 ALLEN ST APT 2C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-2155
Mailing Address - Country:US
Mailing Address - Phone:646-331-2359
Mailing Address - Fax:
Practice Address - Street 1:160 MADISON AVE STE 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5412
Practice Address - Country:US
Practice Address - Phone:929-434-8004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-09
Last Update Date:2021-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY50107436246ZA2600X, 374700000X, 2255A2300X
261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty
No246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, MedicalGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No374700000XNursing Service Related ProvidersTechnicianGroup - Multi-Specialty