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General NPI Number Information
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NPI Number | 1083487599
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Entity Type | Organization
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Legal Business Name | CATHEDRAL LEDGE AESTHETICS AND WELLNESS
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Dates
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Enumeration Date | 11/06/2023
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Last Update Date | 11/15/2023
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Provider Practice Location Address
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Address Line | 1857 WHITE MOUNTAIN HWY UNIT 1
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City | NORTH CONWAY
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State | NH
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Zip | 03860-5158
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Country | US
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Telephone | 603-662-2557
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Fax |
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Provider Business Mailing Address
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Address Line | 1857 WHITE MOUNTAIN HWY UNIT 1
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City | NORTH CONWAY
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State | NH
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Zip | 03860-5158
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Country | US
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Telephone | 603-662-2557
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SOHAIB SIDDIQUI
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Credential |
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Telephone | 603-662-2557
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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