Provider Demographics
NPI:1609752088
Name:LEWIS CORTAZAR, JILL R (LICENSED MASSAGE THE)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:R
Last Name:LEWIS CORTAZAR
Suffix:
Gender:F
Credentials:LICENSED MASSAGE THE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 VINCENT PL
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-3755
Mailing Address - Country:US
Mailing Address - Phone:917-566-9048
Mailing Address - Fax:
Practice Address - Street 1:559 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:EAST ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11518-1530
Practice Address - Country:US
Practice Address - Phone:516-593-8333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011444225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist