1558613562 NPI number — LICE LIFTERS NORTHERN NEW JERSEY LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558613562 NPI number — LICE LIFTERS NORTHERN NEW JERSEY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LICE LIFTERS NORTHERN NEW JERSEY LLC
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:
1558613562
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1245 SUNNYFIELD LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTCH PLAINS
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07076-2219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
908-917-1963
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
353C US HIGHWAY 46
Provider Second Line Business Practice Location Address:
SUITE 215
Provider Business Practice Location Address City Name:
FAIRFIELD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07004-2437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-287-6067
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/15/2012

Additional Information

Authorized Official

Authorized Official Last Name:
RAFAL
Authorized Official First Name:
LISA
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
973-287-6067

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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