Provider Demographics
NPI:1376423947
Name:MAMASSAGE LLC
Entity type:Organization
Organization Name:MAMASSAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIERA
Authorized Official - Middle Name:A
Authorized Official - Last Name:NAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:347-804-3716
Mailing Address - Street 1:495 RUGBY RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-6505
Mailing Address - Country:US
Mailing Address - Phone:347-804-3716
Mailing Address - Fax:
Practice Address - Street 1:603 BERGEN ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-3405
Practice Address - Country:US
Practice Address - Phone:347-687-2709
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-04
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty