Provider Demographics
NPI:1699301168
Name:MERRICK MASSAGE THERAPY PC
Entity type:Organization
Organization Name:MERRICK MASSAGE THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVITON
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:212-962-2262
Mailing Address - Street 1:150 BROADWAY RM 1115
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-4375
Mailing Address - Country:US
Mailing Address - Phone:212-962-2262
Mailing Address - Fax:646-607-4412
Practice Address - Street 1:150 BROADWAY RM 1115
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-4375
Practice Address - Country:US
Practice Address - Phone:212-962-2262
Practice Address - Fax:646-607-4412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty