Provider Demographics
NPI:1699531590
Name:MYOMOOV INC
Entity type:Organization
Organization Name:MYOMOOV INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAURICIO
Authorized Official - Middle Name:
Authorized Official - Last Name:PATINO
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:516-761-5317
Mailing Address - Street 1:350 NATIONAL BLVD STE 2D
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-3327
Mailing Address - Country:US
Mailing Address - Phone:516-200-1213
Mailing Address - Fax:
Practice Address - Street 1:350 NATIONAL BLVD STE 2D
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3327
Practice Address - Country:US
Practice Address - Phone:516-200-1213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty