Healthcare Provider Details

I. General information

NPI: 1124808712
Provider Name (Legal Business Name): LUXXE MEDSPA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 7TH ST STE 303
GARDEN CITY NY
11530-5747
US

IV. Provider business mailing address

233 7TH ST STE 303
GARDEN CITY NY
11530-5747
US

V. Phone/Fax

Practice location:
  • Phone: 419-231-0741
  • Fax:
Mailing address:
  • Phone: 419-231-0741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DESRENE BROWN
Title or Position: OWNER
Credential:
Phone: 419-231-0741