Healthcare Provider Details

I. General information

NPI: 1477368728
Provider Name (Legal Business Name): BEVERLY & CO LUXURY HAIR BOUTIQUE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

49 N CENTRAL AVE APT 507
VALLEY STREAM NY
11580-3861
US

IV. Provider business mailing address

49 N CENTRAL AVE APT 507
VALLEY STREAM NY
11580-3861
US

V. Phone/Fax

Practice location:
  • Phone: 917-459-7569
  • Fax:
Mailing address:
  • Phone: 917-459-7569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: ROSEMARIE THOMAS-SAUL
Title or Position: CEO/CO OWNER
Credential:
Phone: 347-721-4546