Healthcare Provider Details

I. General information

NPI: 1306098330
Provider Name (Legal Business Name): NJ MEDICAL SPAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2008
Last Update Date: 02/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 HACKENSACK AVE FL 10
HACKENSACK NJ
07601-6409
US

IV. Provider business mailing address

401 HACKENSACK AVE FL 10
HACKENSACK NJ
07601-6409
US

V. Phone/Fax

Practice location:
  • Phone: 201-343-3999
  • Fax: 201-343-0554
Mailing address:
  • Phone: 201-343-3999
  • Fax: 201-343-0554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number25MA08396400
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ULYSSES SCARPIDIS
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 201-343-3999