Massage Supreme Therapeutic and Wellness Spa

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

18KT00182400 Issued in NJ

Legal business name

MASSAGE SUPREME THERAPEUTIC AND WELLNESS SPA

Practice address

2168 Millburn Ave
Suite 205
Maplewood, NJ 07040-2640

Phone

(973) 444-0040

Fax

(973) 843-7129

NPI assigned

Apr 13, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Segilade Jobiodeneye

Title

Owner

Phone

(973) 444-0040

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1460505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1460592000000",
    "number": "1427412634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "183A COURT ST",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071033824",
            "telephone_number": "973-444-0040",
            "fax_number": "973-843-7129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2168 MILLBURN AVE",
            "address_2": "SUITE 205",
            "city": "MAPLEWOOD",
            "state": "NJ",
            "postal_code": "070402640",
            "telephone_number": "973-444-0040",
            "fax_number": "973-843-7129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MASSAGE SUPREME THERAPEUTIC AND WELLNESS SPA",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-13",
        "last_updated": "2016-04-14",
        "status": "A",
        "authorized_official_last_name": "JOBIODENEYE",
        "authorized_official_first_name": "SEGILADE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "973-444-0040"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Massage Therapist",
            "state": "NJ",
            "license": "18KT00182400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marigold Pediatric Dentistry and Orthodontics
• Janine Marley, RNC, IBCLC
• Yvette Marshall, LPC
• Martin a. Silverman, M.D., P.a.
• Marven Wallen & S. Kenneth Jacobson, MD PA
• Kenneth Mathews
• Edith Maultsby
• Aprile C Maxie, PH.D.
• Shirley E McColligan, RN
• Emma McDonald, PA-C

• Massage Therapist in Maplewood, NJ
• Providers in Maplewood, NJ by specialty
• Massage Therapist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.