Provider Demographics
NPI:1174078687
Name:LYPOSSAGE A THERAPEUTIC & MEDICAL MASSAGE
Entity type:Organization
Organization Name:LYPOSSAGE A THERAPEUTIC & MEDICAL MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LYPOSSAGE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:RANSDELL
Authorized Official - Suffix:
Authorized Official - Credentials:LP,MMP
Authorized Official - Phone:862-944-5416
Mailing Address - Street 1:716 CLIFTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-3102
Mailing Address - Country:US
Mailing Address - Phone:862-944-5416
Mailing Address - Fax:
Practice Address - Street 1:716 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-3102
Practice Address - Country:US
Practice Address - Phone:862-944-5416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty