Provider Demographics
NPI:1750263802
Name:MASSAGE EVOLUTION P.C.
Entity type:Organization
Organization Name:MASSAGE EVOLUTION P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:MERMELSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:646-285-4952
Mailing Address - Street 1:2000 W FORT LEE RD APT 2215
Mailing Address - Street 2:
Mailing Address - City:BOGOTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07603-1549
Mailing Address - Country:US
Mailing Address - Phone:646-285-4952
Mailing Address - Fax:
Practice Address - Street 1:415 W 57TH ST STE BC
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1752
Practice Address - Country:US
Practice Address - Phone:646-285-4952
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty