Provider Demographics
NPI:1871078618
Name:ARBOLEDA, EVELYN (LMT)
Entity type:Individual
Prefix:MS
First Name:EVELYN
Middle Name:
Last Name:ARBOLEDA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15327 73RD AVE APT 2C
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3050
Mailing Address - Country:US
Mailing Address - Phone:347-285-9713
Mailing Address - Fax:
Practice Address - Street 1:5 NASSAU BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY SOUTH
Practice Address - State:NY
Practice Address - Zip Code:11530
Practice Address - Country:US
Practice Address - Phone:516-505-8360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030503225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist