Active NPI
Jessica Licata, MASSAGE THERAPIST
- Massage Therapist
- Middle Island, NY
National Provider Identifier
1619673787
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 010928
- Practice address
- 1225 Middle Country Rd
Middle Island, NY 11953-2515 - Phone
- (631) 637-6000
- NPI assigned
- Feb 1, 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 | 010928 | NY | Primary |
Addresses
Primary practice location
1225 Middle Country Rd
Middle Island, NY 11953-2515
Mailing address
37 Vee Jay Dr
Shoreham, NY 11786-2249
Phone (631) 379-2270
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 |
|---|---|---|---|
| 010928 | NY | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1675209600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1675209600000",
"number": "1619673787",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "37 VEE JAY DR",
"city": "SHOREHAM",
"state": "NY",
"postal_code": "117862249",
"telephone_number": "631-379-2270"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1225 MIDDLE COUNTRY RD",
"city": "MIDDLE ISLAND",
"state": "NY",
"postal_code": "119532515",
"telephone_number": "631-637-6000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LICATA",
"first_name": "JESSICA",
"credential": "MASSAGE THERAPIST",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-02-01",
"last_updated": "2023-02-01",
"certification_date": "2023-02-01",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "NY",
"license": "010928",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Middle Island, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 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.