Healthcare Provider Details

I. General information

NPI: 1992623490
Provider Name (Legal Business Name): EMBRACE MASTECTOMY BOUTIQUE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 WEYMOUTH DR
HOWELL NJ
07731-1574
US

IV. Provider business mailing address

10 WEYMOUTH DR
HOWELL NJ
07731-1574
US

V. Phone/Fax

Practice location:
  • Phone: 732-832-6906
  • Fax:
Mailing address:
  • Phone: 732-832-6906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224900000X
TaxonomyMastectomy Fitter
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: HENNY HEISLER
Title or Position: OWNER
Credential:
Phone: 732-832-6906