Healthcare Provider Details

I. General information

NPI: 1851632988
Provider Name (Legal Business Name): SAJONIA D'LIGHT SPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2013
Last Update Date: 03/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

856 KEARNY AVE
KEARNY NJ
07032-3211
US

IV. Provider business mailing address

856 KEARNY AVE
BELLEVILLE NJ
07032
US

V. Phone/Fax

Practice location:
  • Phone: 201-428-1550
  • Fax:
Mailing address:
  • Phone: 201-428-1550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number18KT00406800
License Number StateNJ

VIII. Authorized Official

Name: FELIX A FRISCHEISEN
Title or Position: OWNER
Credential:
Phone: 201-428-1550