Healthcare Provider Details

I. General information

NPI: 1962942490
Provider Name (Legal Business Name): NEW YORK LICE TREATMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2017
Last Update Date: 03/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 S OLMSTEAD LN
RIDGEFIELD CT
06877-5529
US

IV. Provider business mailing address

40 S OLMSTEAD LN
RIDGEFIELD CT
06877-5529
US

V. Phone/Fax

Practice location:
  • Phone: 203-948-3327
  • Fax:
Mailing address:
  • Phone: 203-948-3327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name: GREGORY H EISEN
Title or Position: MGR
Credential:
Phone: 203-948-3327