Provider Demographics
NPI:1174386155
Name:MEDICAL MASSAGE NETWORK LLC
Entity type:Organization
Organization Name:MEDICAL MASSAGE NETWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ COO
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:C
Authorized Official - Last Name:VELAZCO
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:201-402-7848
Mailing Address - Street 1:11-19 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-1463
Mailing Address - Country:US
Mailing Address - Phone:201-402-7848
Mailing Address - Fax:
Practice Address - Street 1:11-19 RIVER RD
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-1463
Practice Address - Country:US
Practice Address - Phone:201-402-7848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty