MEDICARE: TRUBEAUTY HAIR STUDIO & HAIR LOSS CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1992567069
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRUBEAUTY HAIR STUDIO & HAIR LOSS CENTER

Provider Business Mailing Address
First Line	:	3 BUCHANAN ST REAR BUILDING
Second Line	:
City	:	CRANFORD
State	:	NJ
Zip	:	07016-3426
Country	:	US
Telephone Number	:	908-380-6868
Fax Number	:

Provider Business Practice Location Address
First Line	:	761 MOUNTAIN AVE REAR BUILDING
Second Line	:
City	:	SPRINGFIELD
State	:	NJ
Zip	:	07081-3223
Country	:	US
Telephone Number	:	908-380-6868
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	STACY DANILLE HAMMOND
Credential	:
Telephone Number	:	908-380-6868

Provider Enumeration Date	:	01/24/2024
Last Update Date	:	01/24/2024

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