Healthcare Provider Details

I. General information

NPI: 1356839138
Provider Name (Legal Business Name): BEYOND CRANIAL BEAUTY , INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2018
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

914 BEDFORD AVE
BROOKLYN NY
11205
US

IV. Provider business mailing address

914 BEDFORD AVE
BROOKLYN NY
11205-5632
US

V. Phone/Fax

Practice location:
  • Phone: 347-927-1172
  • Fax:
Mailing address:
  • Phone: 800-804-8397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: NICOLE JONES
Title or Position: CEO
Credential:
Phone: 800-804-8397