Active NPI
Irta Braziene
- Massage Therapist
- Islandia, NY
National Provider Identifier
1235756404
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 018974-01
- Practice address
- 1717 Veterans Memorial Hwy
Islandia, NY 11749-1532 - Phone
- (631) 203-4300
- NPI assigned
- Jul 2, 2020
- 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 | 018974-01 | NY | Primary |
Addresses
Primary practice location
1717 Veterans Memorial Hwy
Islandia, NY 11749-1532
Mailing address
106 W 5TH St
Ronkonkoma, NY 11779-3843
Phone (631) 738-0208
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 |
|---|---|---|---|
| 018974-01 | NY | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Irta Massage | Single Specialty | Current | Accepting new patients |
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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1593648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1593648000000",
"number": "1235756404",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "106 W 5TH ST",
"city": "RONKONKOMA",
"state": "NY",
"postal_code": "117793843",
"telephone_number": "631-738-0208"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1717 VETERANS MEMORIAL HWY",
"city": "ISLANDIA",
"state": "NY",
"postal_code": "117491532",
"telephone_number": "631-203-4300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRAZIENE",
"first_name": "IRTA",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-07-02",
"last_updated": "2020-07-02",
"certification_date": "2020-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Massage Therapist",
"state": "NY",
"license": "018974-01",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Islandia, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.