Provider Demographics
NPI:1063050060
Name:ALVAREZ, SAUL JUNIOR (LAC, LMT)
Entity type:Individual
Prefix:
First Name:SAUL
Middle Name:JUNIOR
Last Name:ALVAREZ
Suffix:
Gender:M
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 CONNECTICUT AVE
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-3246
Mailing Address - Country:US
Mailing Address - Phone:631-969-6422
Mailing Address - Fax:
Practice Address - Street 1:115 BROADHOLLOW RD STE 10
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-4992
Practice Address - Country:US
Practice Address - Phone:631-969-6422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-20
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171100000X
NY028425225700000X
NY006616171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist