Healthcare Provider Details

I. General information

NPI: 1699418061
Provider Name (Legal Business Name): HEALTHY TEXTURES HAIR CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

869 ALBANY AVE
BROOKLYN NY
11203
US

IV. Provider business mailing address

869 ALBANY AVE
BROOKLYN NY
11203
US

V. Phone/Fax

Practice location:
  • Phone: 718-541-7307
  • Fax:
Mailing address:
  • Phone: 718-541-7307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH C WILFRED
Title or Position: TRICHOLOGIST/COSMETOLOGIST
Credential: IAT
Phone: 718-541-7307