Provider Demographics
NPI:1164301768
Name:HOUSE OF WELLNESS
Entity type:Organization
Organization Name:HOUSE OF WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUTOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-873-0076
Mailing Address - Street 1:3121 31ST ST FL 4
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-2981
Mailing Address - Country:US
Mailing Address - Phone:917-873-0076
Mailing Address - Fax:
Practice Address - Street 1:3121 31ST ST FL 4
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-2981
Practice Address - Country:US
Practice Address - Phone:917-873-0076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-28
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty