Provider Demographics
NPI:1225907587
Name:STEPHANIE DEJOSEPH MASSAGE THERAPY PLLC
Entity type:Organization
Organization Name:STEPHANIE DEJOSEPH MASSAGE THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEJOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:631-894-8467
Mailing Address - Street 1:1315 PETERS BLVD BAY SHORE
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-4801
Mailing Address - Country:US
Mailing Address - Phone:631-894-8467
Mailing Address - Fax:
Practice Address - Street 1:649 W MONTAUK HWY UNIT B
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8222
Practice Address - Country:US
Practice Address - Phone:631-894-8467
Practice Address - Fax:631-666-7051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-04
Last Update Date:2025-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty