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General NPI Number Information
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NPI Number | 1063248870
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Entity Type | Organization
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Legal Business Name | SKIN DEEP ELECTROLOGY, LLC
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Dates
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Enumeration Date | 09/09/2024
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Last Update Date | 09/09/2024
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Provider Practice Location Address
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Address Line | 123 GREEN ST
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City | WOODBRIDGE
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State | NJ
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Zip | 07095-3066
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Country | US
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Telephone | 908-343-3863
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Fax |
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Provider Business Mailing Address
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Address Line | 123 GREEN ST
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City | WOODBRIDGE
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State | NJ
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Zip | 07095-3066
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Country | US
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Telephone | 908-343-3863
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Fax |
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Authorized Official
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Title or Position | LICENSED ELECTROLOGIST
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Name | SAMEERAH CAMPBELL
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Credential | LE
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Telephone | 908-343-3863
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374700000X
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Taxonomy Name | Technician
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License Number |
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License Number State |
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