Provider Demographics
NPI:1447939905
Name:YOLANDA'S MASSAGE PLLC
Entity type:Organization
Organization Name:YOLANDA'S MASSAGE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAVIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-252-8098
Mailing Address - Street 1:28 HASTINGS DR
Mailing Address - Street 2:
Mailing Address - City:FORT SALONGA
Mailing Address - State:NY
Mailing Address - Zip Code:11768-2509
Mailing Address - Country:US
Mailing Address - Phone:516-252-8098
Mailing Address - Fax:
Practice Address - Street 1:24 BELLEMEADE AVE STE B
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-1855
Practice Address - Country:US
Practice Address - Phone:845-827-3637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty