Healthcare Provider Details

I. General information

NPI: 1093695363
Provider Name (Legal Business Name): SAGE88BEAUTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2025
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 W LIBERTY ST
ALLENTOWN PA
18102-2723
US

IV. Provider business mailing address

1105 SCHADT AVE
WHITEHALL PA
18052-2504
US

V. Phone/Fax

Practice location:
  • Phone: 717-287-8247
  • Fax:
Mailing address:
  • Phone:
  • 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 Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MS. SAGE PROCTOR
Title or Position: OWNER
Credential:
Phone: 717-287-8247