1760916936 NPI number — SOLE WELLNESS & AESTHETICS, LLC

Table of content: (NPI 1760916936)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760916936 NPI number — SOLE WELLNESS & AESTHETICS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOLE WELLNESS & AESTHETICS, 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:
1760916936
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/03/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 LAKE AVE APT 7B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST BRUNSWICK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08816-1813
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1235 WHITEHORSE MERCERVILLE RD STE 306
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMILTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08619-3810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-305-0891
Provider Business Practice Location Address Fax Number:
732-510-5236
Provider Enumeration Date:
04/14/2017

Additional Information

Authorized Official

Authorized Official Last Name:
KHALIFA
Authorized Official First Name:
DANIAL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
732-425-7772

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com