1710546155 NPI number — IRIE SALON AND SPA

Table of content: SUMMER DAWN KARAM NP (NPI 1699584789)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710546155 NPI number — IRIE SALON AND SPA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IRIE SALON AND SPA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710546155
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
895 PALISADE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT LEE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07024-4122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-901-6147
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
895 PALISADE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT LEE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07024-4122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-901-6147
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/10/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SENIOR
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
Authorized Official Title or Position:
LEAD THERAPIST, MANAGER
Authorized Official Telephone Number:
917-496-4691

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 302R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 18KT01097200 . This is a "NEW JERSEY OFFICE OF ATTORNEY GENERAL" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".