Active NPI
Jitladda Bannon
- Massage Therapist
- Farmingdale, NY
National Provider Identifier
1164299657
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 033328
- Practice address
- 25 W Oak St
Farmingdale, NY 11735-3121 - Phone
- (516) 376-1503
- NPI assigned
- Dec 5, 2023
- Sex
- Female
- Sole proprietor
- No
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 | 033328 | NY | Primary |
Addresses
Primary practice location
25 W Oak St
Farmingdale, NY 11735-3121
Mailing address
25 W Oak St
Farmingdale, NY 11735-3121
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 |
|---|---|---|---|
| 033328 | NY | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1701734400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701734400000",
"number": "1164299657",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25 W OAK ST",
"city": "FARMINGDALE",
"state": "NY",
"postal_code": "117353121"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25 W OAK ST",
"city": "FARMINGDALE",
"state": "NY",
"postal_code": "117353121",
"telephone_number": "516-376-1503"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BANNON",
"first_name": "JITLADDA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-12-05",
"last_updated": "2023-12-05",
"certification_date": "2023-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "NY",
"license": "033328",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Farmingdale, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.