Healthcare Provider Details

I. General information

NPI: 1124272968
Provider Name (Legal Business Name): JULIET LINGERIE & SWIMWEAR, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2008
Last Update Date: 11/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MAIN ST.
MT. KISCO NY
10549
US

IV. Provider business mailing address

111 MAIN ST.
MOUNT KISCO NY
10549
US

V. Phone/Fax

Practice location:
  • Phone: 914-218-8787
  • Fax: 914-218-8789
Mailing address:
  • Phone: 914-218-8787
  • Fax: 914-218-8789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. MIGUEL ARMANDO NARANJO
Title or Position: MEMBER
Credential:
Phone: 914-666-7542