SERENITY SOURCE MASSAGE CORP (NPI# 1861038291) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861038291 |
| Entity Type | Organization |
| Organization Name | SERENITY SOURCE MASSAGE CORP |
| Practice Address |
18 Weeks St Blue Point NY 11715-1513 |
| Practice Telephone | 6314196300 |
| Mailing Telephone | 6314196300 |
| Enumeration Date | 2019-11-20 |
| Last Update Date | 2019-11-20 |
| Authorized Official Name | DIANE RANDAZZO (PRESIDENT) |
| Authorized Official Telephone | 6314196300 |
| Authorized Official Credential | LMT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | Ambulatory Health Care Facilities |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| New York State Corporations | SERENITY SOURCE MASSAGE CORP | 708 Broadway, Massapequa, Ny 11758 |
| Street Address |
18 WEEKS ST |
| City | BLUE POINT |
| State | NY |
| Zip Code | 11715-1513 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881995405 | Anthony F Pusateri Jr. | Chiropractor | 18 Weeks St, Blue Point, NY 11715-1513 | 2010-11-12 |
| 1710584933 | Stefanie Anne Gambino | Massage Therapist | 18 Weeks St, Blue Point, NY 11715-1513 | 2020-10-01 |
| 1477163822 | Ilene Fox | Massage Therapist | 18 Weeks St, Blue Point, NY 11715-1513 | 2020-07-31 |
| 1689283095 | Lisa Maria Soldano | Massage Therapist | 18 Weeks St, Blue Point, NY 11715-1513 | 2020-07-31 |
| 1356834279 | Tranquil Touch Acupuncture Pt Chiropractic & Massage | Acupuncturist | 18 Weeks St, Blue Point, NY 11715-1513 | 2018-06-14 |
| 1033626767 | Lineesa Sitara Ramadhin | Massage Therapist | 18 Weeks St, Blue Point, NY 11715-1513 | 2018-01-03 |
| 1851749899 | Diane Randazzo | Massage Therapist | 18 Weeks St, Blue Point, NY 11715-1513 | 2016-06-01 |
| 1700156643 | Serenity Source Chiropractic | Chiropractor | 18 Weeks St, Suite A, Blue Point, NY 11715-1513 | 2012-01-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366998684 | Innocentia Nkeiruka Eke | Licensed Practical Nurse | Caring Hands Home Care Inc., 263 Blue Point Avenue, Blue Point, NY 11715 | 2016-08-28 |
| 1013381714 | Marie Solages | Licensed Practical Nurse | 263 Blue Point Avenue, Caring Hands Home Care, Blue Point, NY 11715 | 2015-11-18 |
| 1750750451 | Justine Pomponio | Early Intervention Provider Agency | 24 Norwood Drive, Blue Point, NY 11715 | 2015-09-23 |
| 1447663349 | Alicia Mantione | Behavioral Analyst | 86 Montauk Hwy, Blue Point, NY 11715 | 2014-06-09 |
| 1306013487 | S Paul Zola | Emergency Medicine | 38 W Harbour Dr, Blue Point, NY 11715 | 2008-05-08 |
| 1700924586 | David E. Konnick Jr. | Licensed Practical Nurse | 320 Bluepoint Rd., Bluepoint, NY 11715 | 2007-02-02 |
| 1417093741 | Patricia Cullon Campanelli | Speech-Language Pathologist | 235a Blue Point Ave, Blue Point, NY 11715 | 2007-01-30 |
| 1922044635 | Alejandro Alfredo Godoy | Social Worker | 20 Montauk Highway, Blue Point, NY 11715 | 2006-06-21 |
| 1669909065 | Courtney Perrone | Speech-Language Pathologist | 235 Blue Point Ave, Blue Point, NY 11715 | 2017-05-16 |
| 1578098919 | Evelyn Dwumah | Registered Nurse | 263 Blue Point, Caring Hands Home Care, Blue Point, NY 11715 | 2017-04-24 |
| Find all providers in zip 11715 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356942411 | Medical Offices of Occupational Health Resources P C | Clinic/Center | 240 Airport Rd, White Plains, NY 10604-1315 | 2020-11-05 |
| 1649884537 | Bridge To Care Nurse Practitioner In Psychiatry PC | Clinic/Center | 3005 Church Ave, Brooklyn, NY 11226-4209 | 2020-09-08 |
| 1093328890 | Philomene Goueliani Phd | Clinic/Center | 1461 E 103rd St, Brooklyn, NY 11236-4513 | 2020-08-31 |
| 1801409792 | Lori Davis, Np In Family Health Pllc | Clinic/Center | 317 N Aurora St Ste 200a, Ithaca, NY 14850-4201 | 2020-08-28 |
| 1679190326 | Payless Staffing and Consultants | Clinic/Center | 1332 Commerce Ave Frnt 3, Bronx, NY 10461-3612 | 2020-06-29 |
| 1487279238 | Nss Medical Services, Pllc | Clinic/Center | 322 Linden Blvd., Ground Floor, Brooklyn, NY 11226 | 2020-06-08 |
| 1275157000 | Provident Health Partners Inc. | Clinic/Center | 1529 N Ocean Ave Ste A, Medford, NY 11763-3587 | 2020-06-08 |
| 1922635218 | Proficient Rehab Care Pt Pllc | Clinic/Center | 121 Winham Ave, Staten Island, NY 10306-4930 | 2020-03-25 |
| 1104451525 | Dr Paul Poulakos Do, LLC | Clinic/Center | 186 9th Ave Apt 4f, New York, NY 10011-4918 | 2020-03-05 |
| 1538793732 | Yi Zhang Medical Wellness Pllc | Clinic/Center | 3815 Corporal Stone St Fl 2, Bayside, NY 11361-2140 | 2020-02-26 |
| Find all providers with the same taxonomy | ||||
| City | BLUE POINT |
| Zip Code | 11715 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.