Provider Demographics
NPI:1114746823
Name:ISINMI VILLAGE INC.
Entity type:Organization
Organization Name:ISINMI VILLAGE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MASSAGE THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:GADSDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-800-7263
Mailing Address - Street 1:100 MORRIS AVE STE 103B
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-1423
Mailing Address - Country:US
Mailing Address - Phone:770-331-3343
Mailing Address - Fax:
Practice Address - Street 1:100 MORRIS AVE STE 103B
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1423
Practice Address - Country:US
Practice Address - Phone:862-800-7263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty