Healthcare Provider Details

I. General information

NPI: 1316374762
Provider Name (Legal Business Name): AGGIES FULL BEAUTY SALON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2013
Last Update Date: 10/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 STATE ROUTE 32
VAILS GATE NY
12553
US

IV. Provider business mailing address

5 OLD HEMLOCK DR
NEW WINDSOR NY
12553-7249
US

V. Phone/Fax

Practice location:
  • Phone: 845-476-5385
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: AGATH SALOMON
Title or Position: OWNER
Credential:
Phone: 845-476-5386