Provider Demographics
NPI:1972161339
Name:SB HOLISTIC HANDS LLC
Entity type:Organization
Organization Name:SB HOLISTIC HANDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:HENKOWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-689-0049
Mailing Address - Street 1:2500 NESCONSET HWY BLDG 9B
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-2553
Mailing Address - Country:US
Mailing Address - Phone:631-689-0049
Mailing Address - Fax:631-689-0071
Practice Address - Street 1:2500 NESCONSET HWY BLDG 9B
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-2553
Practice Address - Country:US
Practice Address - Phone:631-689-0049
Practice Address - Fax:631-689-0071
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SB HOLISTIC HANDS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-31
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty