Provider Demographics
NPI:1366996423
Name:MANHATTAN MYOFUNCTIONAL THERAPY, LLC
Entity type:Organization
Organization Name:MANHATTAN MYOFUNCTIONAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OROFACIAL MYOFUNCTIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MACALUSO
Authorized Official - Suffix:
Authorized Official - Credentials:MLT, RDH, MSED
Authorized Official - Phone:646-926-1696
Mailing Address - Street 1:265 MADISON AVE
Mailing Address - Street 2:FL 2
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-0971
Mailing Address - Country:US
Mailing Address - Phone:646-926-1696
Mailing Address - Fax:
Practice Address - Street 1:265 MADISON AVE
Practice Address - Street 2:FL 2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0971
Practice Address - Country:US
Practice Address - Phone:646-926-1696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-06
Last Update Date:2016-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
NY024448-1124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty