IndividualActive
Aleksandr Degtyarev, LMT
NPI 1619651387 · Massage Therapist · Port Jefferson, NY
Provider details
- NPI number
- 1619651387
- Entity type
- Individual
- Primary specialty
- Massage TherapistRespiratory, Developmental, Rehabilitative and Restorative Service Providers
- Credential
- LMT
- Sex
- Male
- Sole proprietor
- Yes
- License
- 032816 (NY)
Specialties & taxonomies
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Practice location
318 Wynn Ln
Port Jefferson, NY 11777-1670
Phone: (917) 224-0464
Approximate (ZIP-level) locationGet directions
Mailing address
81 Westchester Dr
Rocky Point, NY 11778-8875
Registry dates
- Enumerated
- 2023-06-13
- Last updated
- 2023-06-13
- Certified
- 2023-06-13
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.