Provider Demographics
NPI:1154600831
Name:FOR YOURSELF HOLISTIC REJUVENATION CENTER
Entity type:Organization
Organization Name:FOR YOURSELF HOLISTIC REJUVENATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCHESE-ZAM
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, RN
Authorized Official - Phone:516-308-3463
Mailing Address - Street 1:2990 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-5760
Mailing Address - Country:US
Mailing Address - Phone:516-308-3463
Mailing Address - Fax:516-308-3462
Practice Address - Street 1:2990 MERRICK RD
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-5760
Practice Address - Country:US
Practice Address - Phone:516-308-3463
Practice Address - Fax:516-308-3462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003066171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty