Active NPI
Alyssa Rose Genduso
- Massage Therapist
- East Setauket, NY
National Provider Identifier
1083484687
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 033258-01
- Practice address
- 17 Technology Dr
East Setauket, NY 11733-4000 - Phone
- (631) 682-6491
- NPI assigned
- Jan 4, 2024
- Last updated
- Jan 4, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 033258-01 | NY | Primary |
Addresses
Primary practice location
17 Technology Dr
East Setauket, NY 11733-4000
Mailing address
3 Monte CT
Ronkonkoma, NY 11779-8406
Phone (631) 682-6491
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 033258-01 | NY | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ar Wellness Corp | Massage Therapist | Current | Accepting new patients |
Locations
17 Technology Dr
East Setauket, NY 11733
Phone (631) 606-6075
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1704326400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1704326400000",
"number": "1083484687",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3 MONTE CT",
"city": "RONKONKOMA",
"state": "NY",
"postal_code": "117798406",
"telephone_number": "631-682-6491"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17 TECHNOLOGY DR",
"city": "EAST SETAUKET",
"state": "NY",
"postal_code": "117334000",
"telephone_number": "631-682-6491"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GENDUSO",
"first_name": "ALYSSA",
"middle_name": "ROSE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-01-04",
"last_updated": "2024-01-04",
"certification_date": "2024-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "NY",
"license": "033258-01",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in East Setauket, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.